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RECEIVEL) <br /> 0 C T 12 1990 <br /> INVENTORY RECONCILIATION ENVIRONMENTALHLTH <br /> QUARTERLY SUMMARY REPORT PORN <br /> PERMIT/SERVICES <br /> Facility Name: <br /> �Z-� rank Size Product <br /> Facility Address; 7u c, <br /> �; / C�4�tcX U44/ <br /> Telephone ; /2"C) <br /> Person Filing Report kN�L 7 0 /7l.r�iria.t/ <br /> I 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. 1,No is Colurss 13 of the inventory Reconciliation Sheet) <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 ao unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) —" <br /> List date, tank /, and amount for all variations that exceeded the <br /> allowable limits_ <br /> Date rank E Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> i <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 llealch <br /> within 14 hours and an unauthorized release report submitted. <br /> IP. <br /> The Quarterly sumumary report shall be aubmitced within IS days of the end of each <br /> Quarter. <br /> Quarter I - January --) March <br /> Quarter 1 _ April --> June <br /> r .; Quartc_r 3 - July --> September <br /> Q�.artcr 4 - October --> (lcc4•ml,er <br /> Send co: SAN JOAQU I N LOCAL HEALTH DISTRICT <br /> 1601 I: . I'.r►rc 1 t ��n , 1' . 0 . Itc>x 2U()') <br /> 40 10/ H6 tiLockton , CA 95201 460-67b1 <br /> .T <br />