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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM LNVIRONiENTAL HEALTH <br /> Facility Name: DELICATO VINEYARDS Tank i Size Product <br /> 1 <br /> 10,000 Un ea=e <br /> Facility�Address: 19()01 S. Hiehwav 99 2 10,000. Lea e <br /> Manteca_ CA 95336 310,000 7ese <br /> Telephone : (209) 239-1215 <br /> Person Filing <br /> Report Maylie de la Paz <br /> X© 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 13 of the Inventory Reconciliation Sheet) <br /> E] 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 as unauthorized (leak) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date. tank /, and amount for all variations chat exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> 1. <br /> 2. <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 /> M ithin 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 /> Qiarter 2 - April --> June <br /> Quarter 3 - July --> Sepcember <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . Hazelton , P .O . Box 2009 <br /> Stockton , CA 95201 466-678L <br /> IICT 40 10/86 <br />