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IM&TORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />. <br />Facility have. <br />A a �, , <br />hfwcrAND F'_E-1,an -r <br />`-37JL,� <br />C13y O7i <br />Facility Address: <br />64121 1'ADD <br />V11WAy 12 <br />h&MTelephone: r>rno, as -4 eg5240 <br />Personytt— <br />Filing <br />Report <br />t6 <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 />Q Inventory variations exceeded the allowable liaits 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, tank #, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank # Amount <br />1. <br />2. <br />3. <br />4. <br />5. <br />Additional dates/amounts shall be continued on a separate sheet of <br />paper and attached. <br />If the source of the variation which exceedesi a1.o%iab-le lizitz vim: due to <br />a leak the incident shall be reported to S.J.L.H.D. Euviroasental 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 1 - January --> March <br />Quarter 2 — April --> June <br />Quarter 3 — July --> Sepcembcr <br />Quarter( ^ - October --> December 190 <br />Send co: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Hazelton, P.O. Box 2009 <br />Stockton, CA 95201 466-6781 <br />UCT 40 10/86 <br />