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APR 8 1989 <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM �Ft�1""A`HEALTH <br /> 4'rRN14TISERVICES <br /> FaciLity Name: Tank tl Sire. Product <br /> Facility Add reg' UG <br /> 006 e5 e <br /> Telephone : Q'? 7-7 7• E'lTO. --. --.. <br /> 'Person Filin <br /> Report <br /> 19110"1 hereby certify under penalty of perjury that all inventory variations for <br /> the above meationed facility were within the allowable limits for this <br /> quarter. (No in Column 13 of the inventory Reconciliation Sheet) <br /> QInventory variations exceeded theiallowable limits for thin quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) release. (Yea in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List .diate, tack i, and amount for all variations that exceeded the <br /> allowable limits. <br /> Ante Tank 0 Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> S. <br /> Additional dates/amouots shall be continued on n separate sheet of <br /> paper 2nd attached. <br /> It the source of the variation which. exceeded allowable limits was duq! to <br /> a leak the incident shall be reported to S -3 L . H . D_ Environmental licitch <br /> Within 24 hours ..and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the cnd. of cath <br /> (jusrteF_ <br /> Quarter I -- Jaouary --> March <br /> Quarter 2, - April --> June <br /> Quarter 7 - July --> septemhc-r <br /> Quarter 4 - October --> (3tccwher <br /> 5cnd rq_ SAN JOAQUIN 1.0C;A1_ HEALTH DISTRICT <br /> 1601 E , 1) . O . € Wa 1009 <br /> Stockton . CA 95201 466 - 67b l <br />