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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: D . H _ WINN TRUCKING , INC . Tank I Size Product <br /> xofL <br /> Facility--Address: 19555 North Tully Road <br /> P . 0 . BOX 24 . L_os.kpfnrri <br /> Telephone : 2 9-727-5531 <br /> Person Fil g <br /> Report <br /> 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. (Ho in Column 11 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 atot due to an unauthorized (leak) releise. (Yes in Coluam 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank #, and runt for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> It <br /> 1. <br /> 2. <br /> 3. OCT 9 � ^ <br /> ENVIRONMENTAL HEALTH <br /> 4 PERMIT/SE R°JI,;�S <br /> S, <br /> Additional dates/=mounts shall be continued on a separate sheet of <br /> paper and attached. <br /> It the source of the variation which. exceeded at-lovable limits was due to <br /> Y leak the incident shall be reported to S .J L.H . D . Environmental [lea l th <br /> within 24 hours and an unauthorized release report. submitted. <br /> The quarterly summary report shall be isubmicced within 15 days of the end of each <br /> quarter_ <br /> Quarter k - January --> March <br /> Q•sartcr 2 - A ril --> .lune <br /> _:::�arter ] - _July --) scp[em c� <br /> Quarter 4 - Qc[ober t}cccmber <br /> Send co: SAN JOAQUIN 1,0CAL HEALTH DISTRICT <br /> 1601 F . 1 aze f t c,ta , P .0 . 1i" 2()()`) <br /> St_ockc-on , (:A 95201 466-67B1 <br /> M,T 40 10/ 86 <br />