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INVENTORY RECONCILIATT <br /> UARTERLY SUMMARY REPORT <br /> Facility Name: ARF t �i(--n-r � Tank <br /> Sizes Product <br /> Facility Address: ZQZ-7 }eset- <br /> r jar vE <br /> N-- 533 <br /> Telephone: Z03 9Z-S _ 2-1SI <br /> Person Filing <br /> Report: IKE5- 6 S �i SBS-$ <br /> 0 I hereby certify under penalty of perjury that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quarter. (No in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> Inventory variations exceeded the allowable limits for this <br /> quarter. I hereby certify under penalty of perjury that the <br /> source for the variation was not due to authorized (leak) <br /> release. (Yes in Column 13 of the Inventory Reconciliation <br /> Sheet) . <br /> List date, tank i, amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> Date Tank Amount <br /> Reason <br /> 1.AZ-o5 -81_ [ _ <br /> 2. <br /> 3 . <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate <br /> sheet of paper and attached. <br /> If the source of the variation which exceeded allowable limits <br /> was due to a leak, the incident shall be reported to Public <br /> Health Services of San Joaquin County Environmental Health <br /> Division, within twenty-four (24) hours and an unauthorized <br /> release report submitted. <br /> The quarterly summary report shall be submitted within fifteen (15) days of <br /> the end of each quarter_ Circle appropriate quarter. <br /> Quarter 1 - January--------__ March <br /> Quarter 2 - April ------------>June <br /> atter 3 - Jul ------------ P <br /> y >Se tember <br /> Quarter - October ---------->December <br /> w Send to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. Box 2009 <br /> Stockton, CA 95201 <br /> EH 23 019 (209) 468-3420 <br /> (10/89) <br />