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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Hnrton'sl:aa Marr Yank / Size Product <br /> AAq6 000 U/L Premium <br /> Facility�Address: 13475 N. Jacktone Rd. 715 10,000. U/L-Regular <br /> -E. Lodi, CA 95240 .731 12 000 Regular <br /> Telephone : (209) 368-7465 <br /> Person Filing <br /> Reporc Joe Sanzo <br /> El1 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 13of the Inventory Reconciliation Sheet) <br /> © Inventory variations exceeded the allowable limits for tbi■ quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) release. fU31X74W&pJ}1441A3yAtfxK1AK <br /> 1i<33�7b�5ltY}13I}Lx11:4X4Y14X�f (Based on daily measurement error only.) <br /> List date. tank 0, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank E Amouat <br /> 1. SEE ATTACHED INVENTORY CONTROT, SHFFTS <br /> 2. ASTERISKS DENOTE VARIATIONS FxCFFDTNG ALLOWABLE LIMITS. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts %hall be continued on A separate sheet 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 .J .L.H . D . Environmental llcalth <br /> Within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter 1 - January --) March <br /> Quarter 2 - April June <br /> Quarter 3 - July --) Septcmhcr <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . I:aZe1Lcu1 , P .O . Box 2009 <br /> SCOCkton . CA 95201 466-67b1 <br /> UGT 40 10/86 <br />