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INVENTORY RECONCILIATION <br /> OCT 5 1989 <br /> QUARTERLY SUMMARY REPORT FORM <br /> �tdP." hJTGI_H q-- <br /> Facility Name: lam' ir lank i Sise. Product <br /> 1: <br /> Facility�Address: '15cQ z=�icf/ x0-D1 0 „_' <br /> Telephone : 3 6 y i 16 3 <br /> Person Filing <br /> Report <br /> Ja 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 Colu® 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 variation <br /> was not due to so unauthorized (leak) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, 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 /> It 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 --) Harch <br /> Q,iarter 2 - April --> June <br /> Quarter 7 - July --) Jcptcmbcr <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 160L E . Hazelton. P .O . Rok 2009 <br /> SLockton , CA 95201 466 -67bl <br /> LIGT 40 10/ 86 <br />