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716/0 <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: (1 �/ Tank / <br /> Size Product <br /> Facility Address; 7 7 Jj� fgL <br /> ric <br /> Telephone -. <br /> Person Filing <br /> Report 2;V Z//4o57,X-,,4 <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 /> tt:• (iio in CO umn i5 of the Inventory Reconciliation Sheet) <br /> E] 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) releise. (Yes in Column IJ 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. CFLy <br /> z. <br /> J U L 0 6 1,990 <br /> �6 t$j, 3. ENVIRONMENTAL HEALTH <br /> 4. PERMIT/SERVICES <br /> 5. <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 /> garter 2 - April --) Ju e, <br /> Quarter 7 - July --) September <br /> Quarter 4 - October --) December <br /> Send co: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. liazelton , P .O . Box 2009 <br /> Stockton , CA 95201 466-6781 <br /> GT 40 10/86 <br />