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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Fseility Naso: / M � Tank f _ Sue <br /> Product <br /> facility Address: / <br /> Telephone : . <br /> Person Filin � <br /> Report <br /> Ed1 hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were vithin the allovable limits for this <br /> Quarter. (No in Column 13of the Inventory Reconciliation Sheet) <br /> ElInventory variation■ exceeded the allowable Limits for this quarter. 1 <br /> heceby certify under penalty of perjury that the source for the variation <br /> was DOC due Co an unauthorized (leak) reltase. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) I <br /> Gist date, tank /, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Aasount <br /> . 1�OCT1 1 f9�8 <br /> c. EN OONMENTAlHEALTH <br /> S. PERMIT/SERVICES <br /> Additional dates/assounes shall be con(ioued on a separate sheet of <br /> Pa Pcr and aCCached. <br /> It Che source of Che variation vh-ch escceded allow ble IimiCs vas due to <br /> . le" (he inCkdcn( shall be reported to S . J L . H D . Envtronmcntal Ilcalth <br /> within 26 hours and an una,rthoriced rebase re Por( submseted. <br /> 1110 Quar(crlY summary re Port shall 61 sllhmi ((ed within IS days of the end of cacti <br /> 7vartrr . <br /> Quarter I - Jan�.ry --) <br /> Q'Iar(cr 2 - J"IyAVra --) Jv „• Ke) Vp � I <br /> Quarter ) - oc(o --) ]ePtcmhrr ` 0 L- �/ � <br /> QNu rtcr L - OcCabcr --) D.tcrmbcr �� O�LYI <br /> Send to: SAN JOAQUIN LOCAI. HtALIA; UISIKIC-f T' �T I j`1 ` � 1 <br /> 1601 li . Haz(• Il ,nl , 11 . 0 hox 200 <br /> Stockton . CA 95201 460 -61bl <br /> a 40 IO/N6 <br />