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INVENTORY RECONCILIATION JAN 5i989 <br /> J <br /> QUARTERLY SUMMARY REPORT FORM <br /> EWRONOPIE dTAL HEALTH <br /> PERMIT I SERVICES <br /> Facility Name: San Joagiin Lumber Co. Tank / Size Product <br /> Facility Address: 235 W. S cotts Ave. 000 Diesel <br /> Stockton. Ca. - - - <br /> Telephone : 465-5651 <br /> Person Filing <br /> Report Wa. Schneider <br /> ® 1 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 /> ElInventory 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 i, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / 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 whichexceeded al-lovable 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 --) Harch <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --) September <br /> Quarter 4 - October --) Becember <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . Hazelton , P .O . Box 2009 <br /> Stockton , CA 95201 466-678L <br /> LIGT 40 10/86 <br />