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- l <br /> :9 i :+t3 <br /> INVENTORY RECONCILIATION APR 19 199n <br /> Ei".11RONMENTAL HEALTH <br /> QUARTERLY SUMMARY REPORT FORM PERMIT/SERVICES <br /> Facility Name: <br /> �r ; rbc Tank i Size. Product <br /> Facility Address; e' <br /> Telephone : 2-o<_ --A ?y <br /> Person Filing <br /> Report &�A,2e" tl y awe/ <br /> LEE J <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. (No in Columa 13 of the Inventory Reconciliation Sheet) <br /> ElInventory variations exceeded the allowable limits for Ibis quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) releise. (Yes is ColumA 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank 1, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> S. <br /> Additional dates/amounts shall be continued 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 lfealth <br /> Within 24 hours and an unauthorized release report submitted. <br /> The Quarterly su—nary report shall be aubmicted within IS days of the end of each <br /> quarter- <br /> Quart1 - January --) March <br /> Q�artcr 2 <br /> Quarter 3 - July --> septcmhr.r <br /> Q"arter 4 - October --) I).-cemher <br /> Send to: SAN JOAQU I N LOCAL HEALTH U 1 S'1'Iz I C1' <br /> 1601 E . Haze 1 l on , I' . o . It().x 20O'J <br /> '(;T 40 10/ 86 Stockton , CA 95201 460 -61bl <br />