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INVENTORY RECONCILIATT <br /> QUARTERLY SUMMARY REPORT _. .]RM <br /> Facility Name: A L_Tan r Si 7e L Product <br /> to o o raL, <br /> Facility Address: 2 T7 1N <br /> Telephone: za $2 -us1 <br /> Person Filing 0 C Igra <br /> Report: M►Ko; 1�at� ttS Soy -��s $'IQ8 <br /> I hereby certify under penalty of perjury <br /> y ` <br /> that•`a1�:' iriterftbry <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 Reason <br /> 1. b"l- k6--`t 1 <br /> 2. -l 1 -9 1 4-109 <br /> 3 . b7-22-It t 14 <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 /> 91 Quarter - July -------------->September <br /> Quar er 4 - October --------->December <br /> Send to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. Box 2409 <br /> Stockton, CA 95201 <br /> EH 23 039 (10/89) (209) 468-3420 <br /> tQ_►a g l <br />