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I, <br /> INVENTORY RECONCILIATION WR 112 X989 <br /> QUARTERLY SUMMARY REPORT FORM 1'� IRC,II��cz, y,,.r{ ;_r1 <br /> Facility Name: kfI/�rD0C744A"d&,e1 64r, Com. Tank glil0c <br /> e <br /> Product <br /> Tacility 4ddreas: a%E, ' 'L G°�✓L- GA /.� r <br /> U/ eTv�w�7' Z 64t, <br /> .SJ�G,e:�o.yl,� gsZo(y <br /> Telephone : <br /> Person Filing <br /> Report <br /> L 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 Colu® 13 of the laventory 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 Colum 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 /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amouats shall be continued on a separate sheet of <br /> paper and attached. <br /> i <br /> It 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 health <br /> within 24 hours and an unauthorized release report submitted. <br /> T'he Quarterly sum■aary report shall be xubmicted within 15 days of the end of each <br /> Quarter. <br /> QuacCcr I - Jaausry --) March <br /> Q�artcr 2 - April -- June <br /> Quarter 3 - July --> ScPtcmh.-r <br /> Q%jarter 4 - October --) Ikcember <br /> Send to: SAN JOAQU IN LOCAL HEALTH DISTRICT <br /> 1601 E . Haze 1 I on , I' . 0 . liox 2()()') <br /> ;1' 40 10/86Scockcon . CA 95201 466-67bl <br />