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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Date: <br /> FaeiLlty Name: E. F, K1_udt & Sons, Inc, Tank t Size Product <br /> 1 20 000 Unl Plus <br /> Facility<Address: 1126 E. Pine Street 1 20 000 Its lar <br /> Lodi, California 95240 1 20 000 Diesel <br /> Telephone : (209) 368-0634 or Sktn. 466-8969 <br /> Person Fi\ �ing <br /> Report <br /> Ric Tar u <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 /> 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 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable limits. <br /> - '! <br /> Date Tank / Amount V ��EaJ/ <br /> � <br /> 1. <br /> 2. l JAN555J <br /> 3. ENVIROMENTAL HEALTH <br /> 4. FERMIT/SERVICES <br /> S. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> It 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 llealth <br /> within 24 hours and an unauthorixed release report submitted. <br /> The gwarterly summary report shall be Fubmitted within 15 days of the end of each <br /> Quarter. <br /> Quarter I - January --) March <br /> Quarter 2 - April --) June <br /> Quarter 3 - July --) Septemhcr <br /> Quarter 4 - October --) lleccmber <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. . Hazel 1 on . 11 .0 . Rox 2009 <br /> Stockton , CA 95201 466 -67bl <br /> Uc,T 40 I0/ 86 <br />