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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Hortnn'c Cas Marr Tank I size Product <br /> ALq 6,000 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 /> 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 /> 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. kXxxxac;4x9RitWM)NXgtX h14 <br /> 1135X15:C1yXY '�71X�FX7434XfiR14h}� (Based on daily measurement error only.) <br /> List date. tank f, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> 1. SEE ATTACHED INVENTORY CQNTRni, g�mrTS <br /> 2. ASTERISKS DENOTE VARIATIQNS EXURDTNG 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 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 1 - January --) March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> September <br /> Quartcr 4 - October --> Qecember <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 160L E . HazelL<m , P .O . ROX 2009 <br /> SLockron . CA 95201 466 -678L <br /> UCT 40 10/86 <br />