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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM APR z1 �96� <br /> =('J1iiRL?JfJ�d�T.AL i�E,�,'Trl <br /> FacI.i LL tF. Names C(Ik int <br /> �� 'tank I Product <br /> Facilit ,Address: C'e0 b�e_`Icc,_ <br /> y 3� a JAI CC I�-���, 'f_)i <br /> < 1 -+c t-) A Ci-)-,AL u �, on lead d <br /> Telephone : �aog� qct r.4 <br /> Person Filing <br /> Report <br /> 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 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 i, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> ct <br /> 2. c 1 — 142 <br /> 3. JgC1 <br /> 4. 1 Rc— — I1� <br /> s. r a1 �CA +ISS <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which. erceeded 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 /> Q,larter Z - April --) June <br /> Quarter 3 - July --) September <br /> Quarter 4 - October --) rkcember <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 I: . (laze I l(M , 1' . 0 . liox 2009 <br /> Stockton , CA 95201 466 -6781 <br /> CT 40 10/ 86 <br />