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INVENTORY RECONCILIATI <br /> UARTERLY SUMMARY REPORT <br /> Facility Name: F R GIST S; Tank <br /> SizeProduct <br /> �-` Facility Address: Z4 '� '� lketArrc Awe- <br /> Telephone: <br /> ye- <br /> Telephone: . 8�a- �151 <br /> Person Fil ' 9 <br /> Report: E �QG2SSo1 "1$S-89�+� <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 i, amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> Date Tank Amount <br /> Re?so <br /> , I n <br /> 1. i -{� ��C t -9b MeA--*,►amu- + :R <br /> 4112- <br /> 3 . —9ar LVrsc,`` be�t� <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 /> uarter 3 - July ------------>September <br /> uQuarter 4 - October --------->December <br /> Send to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. Box 2009 <br /> G Stockton, CA 95201 <br /> EH 23 019 (10/89) (209) 468-3420 <br />