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INVENTORY RECONCILIATION V APR 171989 <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: ©/'SV Ta k I 5i =1! E:RV1CrPduct <br /> Facility Address: 5>-/V. Acgl <br /> Telephone : 070Q- 0? - <br /> Person Filing <br /> ReporC _ Hyl <br /> E] I hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> quarter. (No in Column 13 of the Inventory Reconciliation Sheet) <br /> QInventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> vas not due to an unauthorized(leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank #, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank # Amount <br /> 1. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shalt 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.Ii . D . Environmental wealth <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 /> quarter. <br /> Quarter I - January --> March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . !'laze 1 scall , P .O . Box 200.9 <br /> Stockton , CA 95201 466-6781 <br /> UGT 40 10/ 86 <br />