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INVENTORY RECONCILIATION- <br /> QUARTERLY SUMMARY RFPORT FORM <br /> Facility Name: Norrnnrc ('ac M', Tank J <br /> Size Product <br /> Facility Address: 13475 N. Jacktone Rd. 6 000 U/L Premium <br /> 715 10,000. U/L Regular <br /> E. Lodi, CA 95240 _ 731 • '12 000 <br /> Telephone : (2091 368-7465 Re ular <br /> Person Filing <br /> Report Joe Sanzo <br /> ❑ 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. (No in Colu= 13 of the Inventory Reconciliation Sheet) <br /> ❑ Iaventory 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. kX)f71X7})XYp*MMU 3XigknhK <br /> Ihvi7E70X78Yw 7ttrnv axYYap}lC7Ffi7G)G]C� (Based on daily measurement error only. ) <br /> List date. caok /, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 1- SEE ATTACHED INVENTORY CONTRnT. ¢Urns <br /> 2. ASTERISKS DEE21L VARIATZOtuS FxrprnTNO ALLOWABLE LIMITS. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which. exceeded aL'lowabLe 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 15 days of the end of each <br /> quarter. <br /> Quarter I - January --) March <br /> Quarter 2 - April --> June <br /> Quarter 3 - JULY --> Septewher <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DIS-1-RIC-1- <br /> 160L E . HazelLun , P .O . Itox 2009 <br /> UCT 40 10/86 SLockton , CA 95201 466 -6781 <br />