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INVENTORY RECONCILIATION <br /> Date $b QUARTERLY SUMMARY REPORT FORM <br /> r � I l <br /> Facility Name: _ E. F. Kludt & Sons, Inc. pTank Size P20 000 Unl Plus <br /> FacilityJlddress: 1126 E. Pine Street 20 000 e leri, a orn a 95240 20',000 iese <br /> Telephone : (209) 369-0634 or Sktn. 466-8969 <br /> Person Fi i g <br /> Report T(yt,� �, <br /> Hichard A. Aivat <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 Coltle�3of _Isvento Tlecancjliltign 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) releise. -Ye■ 1n Column 13 of-the <br /> Inventory Reconciliation Sheet) <br /> List date, tank /r and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> I. ��Vt jt <br /> 2. t 'A:, <br /> 3. N�.._. `' I-Q _.` <br /> A <br /> Add' ionsl dates/amo4q"-"i"'it be continued on a separate sheet of <br /> p er and atta bed. <br /> if a sou of the variation uhich. exceeded allowable limits was due to <br /> a ea a incident shall be reported to S .J .L.H . D. Environmental Health <br /> xn 24 hours and an unauthorixed 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 --) Harch <br /> Quarter 2 - April --> June <br /> Quarter 7 - July --) September <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.. Hazel l on , P .O . ROx 2009 <br /> Stockton , CA 95201 466-67bi <br /> IICI40 10/ 86 <br />