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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: DELICATO VINEYARDS Tank / Size. <br /> Product <br /> 1 10 000. Leaded Gas <br /> FAeility Vlddress: 12001 S0. HWY 99 2 10,000. Unlea e as <br /> MANTECA, CA 9533 3 10, Diese <br /> Telephone : (209) 982-0679 **AND NO OTHERS** <br /> Person Filing <br /> Report Richard D. Larson <br /> ® 1 hereby certify under peaalty 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 /> ❑ 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. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) _ <br /> List date, tank 1, and amount for all variationso,�q6it syzceeded the <br /> allowable limits. five <br /> Date Tank / Amount4 ✓q41 <br /> � k ' <br /> 1. 0/1/ ? 9 1•n� <br /> 2. PFR <br /> 3. C <br /> r <br /> 4. <br /> 5. <br /> Additional dates/amouats 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 --> Septemher <br /> Quarter 4 - October --) (ltcember <br /> Send to: SAN JOAQUIN LOCAL HEALTH DIS'1'HIC1' <br /> 1601 E. Hazelton . P .O . Box 2009 <br /> Stockton , CA 95201 466-678L <br /> T 40 10/86 <br />