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INVENTORY RECONCILIATI <br /> UARTERLY SUMMARY REPORT <br /> Facility Name. '� <br /> YP.Et 'Wr ( 'e�& Tank <br /> Size Product <br /> Facility Address: �2,12 Y� UTc &de � COW L)k L <br /> Telephone: Z Zia 533 6 <br /> Person Filing . i <br /> Report: MAKEc, �z <br /> 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 #, amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> Date Tank Amount <br /> Reason <br /> 1. 0.1 - 1 -q3 <br /> c N''COR-:�e <br /> 2 . o Z-01 `�i ---7 <br /> rs�K <br /> MASu Eu+as- asp <br /> 5. D3-23�-y� f + 1St ,t� <br /> f YtE ,P-'enkCPTr_ <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 - January---------->March <br /> Quar er 2 - April ----------->June <br /> Quarter 3 - July ------------>.September <br /> Quarter 4 - October --------->December <br /> 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 (10/89) (209) 468-3420 <br />