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Inventory Reconciliatinn. Qu•eii; Summary Report Form <br /> DATE: Tank # Size Product <br /> Facil ' t Name. E 1 20.000 Unl Plus _ <br /> F Klndt & Sons Inc. 2 0 0 la <br /> Facility Address : 1.126 E. Pine Stroat20,000 Diesel <br /> Lodi Ca 95240 2,000 Kerosene <br /> Telephone: 209 68-0 3 or 466-3969 2 000 Solvent <br /> Pers n , <br /> Rep: <br /> I hereby 'certify under penalty of perjury that all inventory variations <br /> ® for the above mentioned facility were within the allowable limits for <br /> this quarter. (No in Column 13 of 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 varia- <br /> -4ion was not due to unauthorized ( leak) release. (Yes in Column 13 of <br /> the Inventory Reconciliation Sheet) . <br /> List date, tank # , and amount for ,all variations that exceeded <br /> the allowable limits. <br /> Date Tank # Amount <br /> 1 . J <br /> 2 . <br /> 3 . !� <br /> 4 . <br /> 199, <br /> 5. 11'pGF9l)` <br /> Additional datos/amounts shall be continued on a separ�te sheet <br /> paper and - ached. <br /> If the •source ' the variation which exceeded allowable limits was <br /> due to a leak, the incident shall be reported to San Joaquin Local <br /> health District; Environmental Health Division, within twenty-four <br /> ( 24 ) hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within fifteen ( 15 ) days <br /> of the end of each quarter. <br /> Quarter 1 - January---------->March <br /> Quarter 2 - April------------>June <br /> Quarter 3 - July------------->September <br /> Quarte - ctobcr---------->December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton, P.O. Box 2009 <br /> Stockton, CA 95201 468-3420 <br /> Ell 23 019 10/86 <br /> �k (Iiake a ooPY (yellou) for Kludt files and attach invent oEYReeoncil.i.ation records for <br /> sll tanks. ) <br />