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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM �P� 1 <br /> Facility Name: _A ANA �1I.;E`J�„�>t �x�p>�(\1 ,��c� Tank i size Product <br /> Facility Address: 13 9 \ pS C0) - -- Ave-- nc / L.i=' <br /> MAr.iTis'_A .ia -I533Lc - � 1 C1/.r <br /> Telephone : 5`75 <br /> Person ,F� ling n <br /> Report `� ��! <br /> 13 I hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> quarter. (No in Colum 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 unauthorised (leak) release. (Yes in Colum 13 of the <br /> T <br /> Inventory Reconciliation Sheet) <br /> List date, tank #, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date T= ,Amount <br /> -- - -_S�p <br /> Z. <br /> c�3. uCdV��JC �c m Co6L2� <br /> i. �CT�� <br /> p�-c �- 1. !i �L AS PELIVE�y - P <br /> C ��AS=-S71�LC�LO -LtSEp `rErnP '(-oR C� S� <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 Health <br /> Within 24 hours and an unauthorised release report submitted. <br /> The quarterly summary report shall be submitted within IS days of the end of each <br /> • quarter. <br /> Quarter 1 - January --> March <br /> Quarter 2 - April June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL. HEALTH DISTRICT <br /> 1601 E. Hazelton , P .O . Box 2009 <br /> Stockton , CA 95201 466-6781 <br /> UGT 40 10/86 <br />