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INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility. Name: ALVE-/�VIIW M& <br />Facility -'Address: 7M--jJOksTeiAc �-.0de. <br />- . '' ZZZI� vrfclll. /A VJ --&S- . <br />Telephone:(ZOcO 2 3 7-410 (� <br />Person F ing <br />Report <br />JUN 161989 <br />1 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 Column 13 of the lovcutory Reconciliation Sheet) <br />❑ Inventory 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 Colum 13 of the <br />Inventory Reconciliation Sheet) <br />List date. tank 1, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank F Amount <br />Additional dates/amounts shall be continued on a separate ■heat of <br />paper and attached. <br />If Che source of the variation which. exceeded allowable limits was due to <br />a leak the incident shall be reported to S.J.L.H.D. Environmental Health <br />within 24 hours and an unauthorized release report submitted. <br />The Quarterly summary report shall be submitted within IS days of the end of each <br />Quarter. <br />Quarter I - January•--) March <br />Quarter 2 - i __> June <br />Quarter ] - July --) September <br />Quarter 4 - October --) December <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. IlazelLnn, P.O. Box 2009 <br />Stockton, CA 95201 466-6761 <br />EH 23 019 10/86 <br />