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INVENTORY RECONCILIATION 0c1 1 '1 <br /> QUARTERLY SUMMARY REPORT FORM ENVIRONIvtcNiAI-H'EALTH <br /> PERMIT 1 SERVICES <br /> Facility Name: ygepav,���uUei Gp _ <br /> Tank I Size Product <br /> facility,Addrese: c: c1W,&—oquJy-; Z �Tz��G 11 <br /> Telephone : <br /> Person Filing / <br /> Report ,r,;A(avo,✓?�_ <br /> 1 hereby certify under penalty of perjury that all inventory variations for <br /> 'be 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) releise. (Yes is 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 I Amount <br /> I. <br /> 2. <br /> 3. <br /> 4. <br /> S. <br /> Additional dales/amouaix 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 co <br /> a leek the incident shall be reported to limits <br /> Environmental Health <br /> Within 24 hours and an unauthorized release report submiCted. <br /> The quarterly summsry report shall be r;ubmi <br /> quarter_ tied within IS days of the end of each <br /> Q1 e - APS --� ut <br /> —� arCer - July <br /> Send to: SAN JOAQUIN LOCAL. HEALTH DISTIt ] C'I' <br /> 1601 E . 1' . O . 1ic>x 2OO9 <br /> Stockton , CA 95201 466 -67b1 <br /> ;1' 40 10/86 <br />