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INVENTORY RECONCILIATION' <br /> QUARTERLY SUMMARY Rf_PORT FORM <br /> Facility Names Horron's (:ac mnrr Tank I Size Product <br /> ri 6. 000 U/L Premium <br /> Faeility,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 /> 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 Column 13of the Inventory Reconciliation Sheet) <br /> QInventory 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. kxlaaxi twM kXKh14 <br /> Y'�� Y'�' iX`i}174?3Y$k�1G74� (Based on daily measurement error only.) <br /> List date, tank /, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 1. SEE ATTACHED INVENTORY CONTunT. SAEETS <br /> 2. ASTERISKS DENOTE VARIATIONS EscEED1 G ALLOWABLE LIMITS. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amouots shall 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 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 --> September <br /> Quarter 4 - October --) fhcember <br /> SAN JOAQUIN LOCAL HEALTH OIS'1'kIC1' <br /> 1601 E . HazellI)n , P .O . Box 1009 <br /> UCT 40 10/86 Stockton , CA 95201 466 -67bL <br />