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90 <br /> INVENTORY RECONCILIATION '� <br /> QUARTERLY SUMMARY RF_PORT FORM .3 <br /> Facility Name: �� G moTank I Size Product <br /> -2�W.TJn,VzF& "'tb <br /> Facility 'Address: Ae &OK '<?CW,2 <br /> Telephone : C/- 7p, f� e, 000G <br /> Person Filing .. ooG4 p - <br /> Report <7, 1)sft77,P <br /> EJL 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 /> Iaventory 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) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank 1, and amount for all variations Chat exceeded the <br /> allowable limits- <br /> Date Tank R Amount �� CoAtDir��tipot7t� �Pg <br /> 1- � /�' S 23 �.�m,�z G,✓ �'s`/ff ,Lbricicn�cv.� rlr�rr <br /> 2. /opmb/ ,Div 't'vr-me" <br /> 3. ��✓�acn.c�✓A .see 17t tr' <br /> 4. <br /> 5. div Gue ��/y/fr'�l ✓ �cr� <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 allowable limits was due to <br /> a leak the incident shall be reported to S .J .L.H . D . Environmental Ilea ICh <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 /> Quarter 2 - April --> June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazellim , P .O . Box 2009 <br /> Stockton , CA 95201 466-67b1 <br /> JCT 40 10/86 <br />