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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: lfk.r�roFnuc �14��Z$®�T Tank t Size Product <br /> PHONE: 323-57173 :z .7L c �. <br /> Facility Addrese824-EAST Yn�j, 1,ray 1",ija�t <br /> WANTECA <br /> r.ar < 6 <br /> Telephone : <br /> Person Fi1 'n <br /> Report <Zti / <br /> hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility: wcrr within the allowable limits for this <br /> quarter. (No in Column 13of 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 an unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) ' <br /> List date. tank II, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank E Amount <br /> I. "."'� t1l <br /> J2.. � <br /> 1987 <br /> 4. <br /> 5. ENVIROMENTAL HEALTH <br /> FERMIS/SERVICES <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 /> a leak the incident shall be reported to S .J . L. H . D . Environmental Ilcalth <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 /> quar(er. <br /> Quarter I - January --) March <br /> Qjarter 2 - April --> June <br /> Quarter 3 - July --) september <br /> Qiarter 4 - October --) Ikcember <br /> Send to: SAN JOAQUIN LOCAL HE:ALTh DISTRICT <br /> 1601 F. . Haze l IOn . P .O 1")X %00'9 <br /> Stockton , CA `I'i201 4I:.,, -67b1 <br /> lll;'1h0 lil;' ,4i� <br />