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INVENTORY RECONCILIATION APR 17 1989 <br /> QUARTERLY SUMMARY REPORT FORM II <br /> Facility Name: J6VZ1dA FID/fr] Ta k # Six '--1,:A?1!'/SERW$ i4uct <br /> ��f , A t Or'I <br /> Facility Address: 5� /w • /*llQl• S a <br /> a.4 e <br /> Telephone : C96?- 02 ;9- <br /> Person Fil',ng <br /> Report ✓0 oSKe' <br /> © 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 penury that the source for the variation <br /> was not due to an unauthorized (leak) release. ('fes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank #, and amount for 211 variations that exceeded the <br /> allowable limits. <br /> Date Tank # Amount <br /> 2. <br /> 3. luy r <br /> � w 4. 96-70G <br /> Additional dates/amounts shall 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.H .D. Environmental HeaLth <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 . Haze] Lon , P .D . Box 2009 <br /> SLockton , CA 95201 466-6781 <br /> UCT 40 10/ 86 <br />