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ENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Name: Lam 'Let" �i (4 <br />Facility Add reas: -Zdc , <br />Telephone: <br />Person Filing <br />Report <br />1096'21V�9 <br />APR 2 7 1989 <br />Tank # EN" ftmw - = . uct <br />I11 SE VICFiS <br />�2 <br />L-61 <br />I hereby certify under penalty of perjury that all invautory 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 unauthorised (leak) release. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date$ task #, and aaount for all variations that exceeded the <br />allowable limits. <br />Date Tank # Amount <br />1. <br />2. <br />3. <br />4. <br />S. <br />Additional dates/amounts shall be continued on a separate sheet of <br />paper and attached. <br />If the source of the varix- -» "hick exceeded allowable limits was due to <br />a leak the incident shall be reported to S.J.L.H.D. Environmental Lcalth <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 />QuarterLl. - 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. liazelton, P.O. Box 2009 <br />Stockton, CA 95201 466-6781 <br />UCT 40 10/86 <br />