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e <br /> (/ l� INVENTORY RECONCILIATION s OCT 1 2 1988 <br /> QUARTERLY SUMMARY REPORT FORM <br /> ENVIRCN'v1ENTAL HEALTH <br /> PERMIT r'SERVICES <br /> Facility Name: �/ — Tank I Size. Product <br /> o O .YE <br /> Facility;Address: 9SO yi�L rS/�/SPL <c'. <br /> 7z)C.'3-row- Gam. <br /> Telephone : aa9- 9�z- �Jlo D 6 <br /> Person Filin <br /> R <br /> Re ort ort <br /> L hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> Quarter. (No in Colum 13of the Inventory Reconciliation Sheet) <br /> ElInventory variations exceeded the allowable Limits for this Quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) releise. (Yes in Column 13 of the <br /> Laventory Reconciliation Sheet) <br /> List date, tack I, and amount for 211 variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 1. <br /> 2. <br /> J. <br /> 4. <br /> 5. <br /> Additional daces/assouots shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation vhich. cxceeded allowable limits was due to <br /> a leak the incident shall be reported to S .J . I.. H . D . Environmental Health <br /> Within 24 hours and an unauthorized release report submitted. <br /> The Quarterly summary report shall be Kubmitted within 15 days of the end of each <br /> Quarter. <br /> Quarter I - January --> March <br /> Quarter 2 - April --> June <br /> xQuarter 7Q - July --> beptcm Mer , <br /> Quarter 4 - October --) December <br /> Send to; SAN JOAQUIN LOCAL HEALIH DISIR ICT <br /> L60L E . Hazelton , P . O . hox 2009 <br /> StotkFton , CA 95201 466 -67b1 <br /> 40 10/R6 <br />