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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: tiQ1 ���t��«F/ Tank t <br /> Size Product <br /> , <br /> Facility,Address: c. <br /> f _ � <br /> Telephone : U.f <br /> Person Filing <br /> Report <br /> QI hereby certify under penalty of perjury that all inventory variations for <br /> -he above mentioned facility were within the allowable limits for this <br /> quarter. (No in Column 13 of the Inventory Reconciliation Sheet) <br /> ElInventory 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 i, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank F Amount <br /> L L <br /> 2. - APR 1 2 1951 <br /> 3. <br /> ENVIRONMENTAL HEALTH <br /> 4- PLRWHIT/SLIR IC13 <br /> 5. <br /> Additiooal dates/amounts &hall be continued on a separate sheet of <br /> paper .and attached. <br /> i <br /> If the source of the vada. which exceeded allowable limits was due to <br /> a leak the incident shall be reported to <br /> S .J . L. H . D. Environmental 1lcalch <br /> within 24 hours and an unauthorized release repore submitted. <br /> The Quarterly summary report shall be Rubmitted within 15 days of the end of each <br /> quarter_ <br /> LQuarter I - Jaouary --) March <br /> Q.sartcr 2 - April --Y Junl <br /> Quarter I - July --) September <br /> QAarter 4 - October --) lkcrmt,er <br /> Send to: SAN JOAQU I N LOCAI, HEALTH DISTRICT <br /> 1601 I: . Haze l i 4tn , 1, .O . Ilex 'lOOg <br /> �' 4U 10/86 Stockton , CA '15201 460-61b1 <br /> � <br />