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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORMA \NF � <br /> Facility Name: U��/�� �?i« / :;_Gc Tank I Size d ct <br /> �06y! -/4oral s <br /> Facility 'Address. 5 - c < x L <br /> Telephone : j-.0 4;�J ,a yy- ?0_2r <br /> PersonFil�i�nS <br /> Report <br /> ✓a 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 /> quarte.. (No a C.-.Luc !3c.' th;_ lavcazory '.e. onc:l:ati.... <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 am unauthorized (leak) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank i, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank E Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be contioued on a separate sheet of <br /> paper and attached. <br /> If .the source of the- variation which. exceeded ahlowab.le - limits was .due-to <br /> .a leak the incident shillbe reported to S _J .L._H . D . Environmental llcalth <br /> within 24hoursand an unauthorized release report submitted. <br /> The Quarterly summary. repo.rc �shall be submitted .within 15 days of the end of :each <br /> Quarter. <br /> Quarter 1 - January --) .March <br /> Quarter 2 - April --)June <br /> Quarter 3 - 'July - --> SeptemM•r <br /> Quarter 4 - Octobcr --> December <br /> Send co: SAN JOAQUIN LOCAL HEALI.1i DISTRICT <br /> 160L E . Hazelt <ut , P .O . Box 20()9 <br /> SLockcon . CA 95201 466-67b1 <br /> ,ICT 40 10/ 86 <br />