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0 <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Name:L0 Mil -1 S jt4(_ Tank. I <br />Facility Address: W <br />e4-,4 C-0 G4s346 <br />Telephone: 2k S)q �{�D <br />Person Filing <br />Report: i( �L QtNcI <br />a <br />AUG 07""l <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />Size Product <br />�a, �=4 �W 4, <br />F] I hereby certify under penalty of perjury that .all inventory variations <br />for the above mentioned facility were within the allowable limits for <br />this quarter. (No in Column 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 varia- <br />tion was not due to unauthorized (leak) release. (Yes in Column 13 of <br />the Inventory Reconciliation Sheet). <br />List date, tank #, and amount for all variations that exceeded <br />the allowable limits. <br />Date, Tank # [amount <br />z . <br />q-1 - IL� 6-13) r1_3,4_% <br />2. 6-S .1 1�g 6-011L � <br />3. 6-11 <br />4. 6-13 LU CQICIA� <br />5. 6 -,) t d15 [� <br />Additional dates,/amounts shall be continued on a separate sheet <br />paper and attached. <br />If the source of the variation which exceeded allowable limits was <br />due to a leak, the incident shall be reported to San Joaquin Local <br />Health District; Environmental Health Division, within twenty-four <br />(24) hours and an unauthorized release report submitted. <br />The quarterly summary report shall be submitted within fifteen (15) days <br />of the end of each. quarter. <br />Quarter 1 -- January ---------- >March <br />Quarter 2 - April ------------ >June <br />Quarter 3 - July ------------- >September <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 468--3420 <br />Ell 23 019 10/86 <br />