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/90 <br /> INVENTORY RECONCILIATION /// <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Names _ d1n 42 e2:) Tank 1 Sise Product <br /> Facility 4ddressz D <br /> 006) <br /> UQ Don � <br /> Telephone : r/I/ <br /> Person Filing <br /> Report IT�a nn <br /> ElI 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 Column 13 of the In:•e.ctory 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_ e <br /> Date Tank f <br /> Amount •-� <br /> 1. y D 90 /ri � + krttt <br /> 2. <br /> J IV Ls � <br /> 3' �' �O i �3s -ENVIRONMENTAL HEALTH <br /> 4. PERMIT/SERVICES <br /> 5. b 9c /4Zo <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached_ <br /> If the source of the variation whichexceeded 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 /> The quarterly summary report shall be submitted within 15 days of the end of each <br /> quarter_ <br /> Quarter I - January --) Harch <br /> Qiarter 2 - April --) June <br /> Quarter 3 - July --> Scptcmhcr <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQU IN LOCAL HEALTH DISTRICT <br /> 1601 E . Raze 1 torn , P . 0 . 1iox 1009 <br /> Stockton CA 95201 466 -67b1 <br /> GT 40 10/ 86 <br />