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INVENTORY RECONCILIATION u <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Horton's Gas Marr Tank i Size product <br /> AlIg 6,000 U/L Premium <br /> Faeility,'Address: 13475 N. Jacktone Rd. 715 10,000. U/L Regular <br /> E. Lodi, CA 95240 731 42,000 Regular <br /> Telephone : (209) 368-7465 <br /> Person Filing <br /> Report Joe Sanzo <br /> E] I 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. (Ho in Column 13 of the Inventory 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) release. fXxxx:4?}•x9R*xmtA1mkx-khA <br /> IE74'GIOXX' Y'v+x�`xuXb74X$�7S14b3� (Based on daily measurement error only.) <br /> List date, tank 1, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 1. SEE ATTACHED INVENTORY CQNTROT. SARFTS <br /> 2. ASTERISKS DENOTE VARIATIONS TIXCRED1 G ALLOWABLE LIMITS. <br /> J. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate ghee[ of <br /> paper and attached. <br /> If the source of the variation which. exceeded allowable limits was due to <br /> a leak the incident shall be reported to S .L .H . D. Environmental health <br /> within 24 hours and an unauthorized release report submitted. <br /> The Quarterly summary report shall be xubmitted within 15 days of the end of each <br /> Quarter. <br /> Quarter 1 - January --) March <br /> Q,iarter 2 - April --> June <br /> Quarter 3 - July --) September <br /> Quarter 4 - October --> Gkcember <br /> Scnd to• SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 160L E . 11azelLo tl . P .O . Box 2009 <br /> Stockton . CA 95201 466 -6781 <br /> UCT 40 10/ 86 <br />