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r� <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facilicy Name: D . H . WINN TRUCKING , INC . Tank f Size Product <br /> i IJCJ i7 717-7 <br /> FaciLity :Address; 19555 North Tully Road <br /> P . 0 . BOX 24 <br /> Telephone : 209-727-5531 <br /> Person Filing <br /> Report `lu-�L2 7 <br /> ac I here 6,y 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 /> QInventory 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 as unauthorized (leak) release. (Yes in Col-an 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable limits. <br /> Dart Tank f Amount <br /> RECEIVED <br /> �. JUL03 990 <br /> 2. -NV IRONMENTAL HEALTH <br /> 3. PERMIT/SERVICES <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on x separate sheet of <br /> paper and attached. <br /> If the source of the variation which. cxceeded allowable limits vas due to <br /> a leak the incident shall be reported to S ,J ,1„ H _ D . Environmental Ilea l t h <br /> within 24 hours and an unauthorized release report submitted_ <br /> The quarterly summary report shall be Nubmitted within 15 days of the end of each <br /> quarccr. <br /> Quar C I - Jaouary --> »arch <br /> darter 2 April --> June <br /> Quarter-3 - July --> September <br /> Quarter 4 - October --> (}ccember <br /> Send to: SAN JOAQUI.N L()CAI, HEALTH DISTRICT <br /> 1601 F , Haze f t (11, , P . 0 . li<�x )0(7x) <br /> SLockton . CA 95201 466 -6781 <br /> IM, 1r0 10/ 80 <br />