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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name; �iIALDD iy >�,vpV,e� CsN►S�GROC. Tank I <br /> Size Product <br /> Facility�Address; t?O� rC qy�,�•�r ,, /2oov sae <br /> -�'TacKTO.y cam► 9't s�b [�� -tEw GMoI � <br /> Telephone : _ (2o9) <br /> Person Filing <br /> Report <br /> �i,�io c vo o�✓ Y o: i��✓ <br /> I hereby certify under penalty of perjury that all inventory variations for <br /> 'he above mentioned facility were within the allowable J;nits for thin <br /> quarter. (No in Column 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 an unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) _ <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable limits_ <br /> Date Tank f Amount <br /> 2. _ U <br /> 3- APR 81988 <br /> 4. <br /> ENVIROMENTAL HEALTH <br /> 5• FERMIT/SERVICES <br /> Additional daces/amounts shall be continued on a seoarate 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 inc idem steal l be reported to S .•J _ L.H . D . env i ronmenta l Ilea l th <br /> within 14 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter I - January --) HTIch <br /> Q,jarter 2 - April --) June <br /> Quarter 3 - July --> septemhcr <br /> Q%Aartcr 4 - October --> Ikci mhcr <br /> Send to: SAN JOAQU I N LOCAI. HEALTH D 1 STR I CI' <br /> 1601 f; . 1'.:�zt� 1 i ��n , P . O . Box 2009 <br /> ic;T 40 10/86 Stockton . CA 95201 460-67b1 <br />