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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Fac.Wty. Names 2/P6 Tank tZ Site. <br /> Product <br /> Facility�Addreaa: 3.212- IVv 00c) 6 / <br /> Ca /, own, /ococ <br /> Telephone : c, 3 <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 /> /O" 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 I Amount <br /> 2. <br /> 3. / OCT 2 1988 <br /> 4. PJ14 <br /> 5. 8 <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 /> At 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 Rubmitted within 15 days of the end of each <br /> quarter. <br /> Quarter I - January --) Harch <br /> QQjarter 2 - April --) June <br /> Quarter 3 - July --> Septcmhcr <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQU IN LOCAL HEALTH DISTRICT <br /> 160L E . haze 1 ( ()n , P . O . Itox 2OOg <br /> Stockton , CA 95201 466 -67bt <br /> JGT 40 10/ 86 <br />