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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Mase: t_.L � Tank fee <br /> Product <br /> Facility Address: <br /> E-710 117 <br /> Telephone : . <br /> Person F111n <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 13of the Inventory Reconciliation Sheet) <br /> ❑ Inventory variations exceeded the allowable limits for this quarter. L <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) release. (Yes in Colum 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tack f, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> ( P 11, y4g <br /> OCT 11 1988 <br /> 4, WORONM_NTAL I-fEALTFI <br /> S. PERMIT/SERVICES <br /> Additional dates/amountx chall be contioued oa a separate sheet of <br /> paper and attached. <br /> if (he source of 1110 variar on ..h-ch eseceded aI1,uable limits . as due co <br /> • leak (he LOC tdcn( shall be rcpor (cd rn $ . J I {{ D . Envtro nmcn(al Ilcal ( h <br /> wt(hin 24 hours and an unau[horiccd release repor( submt(ted- <br /> the at.+r(erly sua•aary repnr( shall hr submi ((ed �i(htn 15 days of (he end of each <br /> Quar(cr 1 - Janu.ry __) M.lrr11 <br /> Qaarlcr I - Apra l --) ep( <br /> S <br /> Quar(cr ) - July __) 0p(cmhrr <br /> Q <br /> �a rYcr 4 - OcCabcr --) Il.rcrmber +0 <br /> Send CO: SAN JOAQUIN LUCnI. HEALTH UItiIHICf -r �n &4A(�J <br /> 1601 li . I:azcI1 ,n1 , 1' . 0 Hox /00 <br /> Stockton , CA '15201 466 -61b1 <br /> JI:T 40 I ()/ H6 <br />