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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Home: Tank 0 SizeProduc <br /> Facility Address: M' �_ �`S • <br /> Telephone : '7 <br /> Person Filing <br /> Report <br /> E] 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 13of the Inveatory 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 /> gra■ not due to as unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank /, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 1- I I I 1 4 3 - I <br /> 2. <br /> 3. S a <br /> 4. k+F <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 /> it leak the incident shall be reported to S _J .j„ N . D . Env ironmenta I Ilea It11 <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 --> tlarch <'•' <br /> Q•larter 2 - April --> Jurr4! D <br /> Quar[ 7 - July (,te--) Se mper <br /> .rr _ <br /> Q+,artcr 4 - October --> [lccember JUL11 1.}1 QO 4988 <br /> Send to: SAN JOAQUiN l,()(:Ai. HEAL T11 DI :iT IM:T <br /> 1601 H . If:lrc 1 [ r+i� , 1” . (} I,.S:: 1.(111r) ENVIROMENTAL HEALTH <br /> '�PERMIT/SERYICF,S� <br /> `�t. <,cktan , (:11 `152{) 1 /"l,r) -f, lbl <br />