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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facillity Name;/ _yam <br /> -----� /"/ �K rank 8 site <br /> � Pr�9dr, <br /> Pmcility Addccas; /�� Afl'�SVAI WAy <br /> Telephone : (�cl <br /> Person Filing <br /> Report _ /�t�CA/ - <br /> hereby certify under penalty of perjury that all inventory variatioos <br /> the above oeGCioned facility were within the alloumble limits for this for <br /> Quarter. (No in Column 13of the Inventory Rcconci.li_tion Sheet) <br /> Inventory variations exceeded the allowable limits for thin Quarter. i <br /> hereby certify under penalty of perjury that the source for the variation <br /> was Got due CO an unauthorized (leak) releiae. (Yes is Column 13 of the <br /> Inventory Reconciliation sheet) <br /> List date, tank 0, and aaaunt for all variations that exceeded the <br /> allowable limits_ <br /> Date Tank 0 Amount RECEIVE <br /> 1. <br /> 2 - - -- JUL 11 1990 <br /> 3. — — cIVVIRONMENTAL HEALTH <br /> — PERMIT/SERVICES <br /> 4. !— <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> Lf the source of the variation whichexceeded allowable limits was due to <br /> a leak the incident shall be reported to S .J ,L.H. D. Environmental Ncalth <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 /> QAarter 2 - April --> June <br /> Quarter J - July --) Sc ptcmhcr <br /> Quarter 4 - October -_) December <br /> Send to: SAN JOAQUIN LOCAL HEAL7'li OISTRICT <br /> 1601 E . Bare1l011 . P .O . ROx 2009 <br /> Stockton . CA 95201 466-6761 <br /> Eli 23 019 10/86 <br />