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i,AIAR 2 'J 6-F <br /> INVENTORY RECONCILIATION <br /> ENVIRWOENTAL HEALTH <br /> QUARTERLY SUMMARY REPORT FORM FERMIT/SERVICES <br /> Facility Name: Tank i Size Product <br /> Facility Address: GFcc) <br /> LL e:: <br /> Telephone : -A <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 /> ti Inventory variations exceeded the allowable limits for this quarter. T <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 1, and amount for all variations that exceeded the <br /> allowable limits_ <br /> Date Tank I Amount <br /> 44 <br /> 9, Z + <br /> 3. <br /> 4. <br /> S. <br /> cantim-ued on a sepzrz-te sheet of <br /> paper and attached. <br /> If the source of the variation which. exceeded 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 I - January March <br /> Q,iarrcr 2 - April Jklile <br /> %� uartcr 3 - July September F-7 <br /> Qtiartcr 4 - October comber <br /> Semi ca: <br /> SAN JOAQUIN 1.0CA1. HEAL-1.1i DISTRICT <br /> 1601 1-. . -Ha,,clt mi . P . 0 , 1,()x )009 <br /> S(. ockcon . CA 95201 1460 -67bl <br /> W;T 40 10/ 86 <br />