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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: JL14 At L) TaEk I Size Product <br /> A 4 0 t!J✓1 �,� C�i <br /> Facility Address: !�• f'Jc�//? J!. <br /> Telephone : _ Q209 - o23? - ?/ <br /> Person Film� <br /> Report 65 <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 113of the Inventory Reconciliation Sheet) <br /> Inventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) release. (Yes in Colum 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. 2&,eSee 1Ud S J�7 TI <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amouots 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 --? !Barth <br /> Quarter z - April June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL. HEALTH DISTRICT <br /> 1601 E , Hazelton , P .O . Box 2009 <br /> Stockton , CA 95201 466-6781 <br /> UGT 40 10/86 <br />