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f11 % <br /> INVENTORY RECONCILIATION c! ,_, <br /> QUARTERLY SUMMARY REPORT FORM t'U <br /> VIROME^TPL HEALTH <br /> c EN SE'iVIC�S <br /> Facility Hamlet Tank I Stse Product <br /> Facility Addresatj <br /> Telephone : - — <br /> Person Filing <br /> Report ( <br /> i <br /> I hereby certify under penalty of perju that all inventory variations for <br /> the above mentioned facility were within the allowable Limits for this <br /> Quarter. (No in Colu® I3of the loventocy Reconciliation Sheet) <br /> ❑ loventocy variations exceeded the allowable limits for this quarter. T <br /> hereby certify under penalty of perjury that the source for the variation <br /> vas cot due to an uuauthoriced (leak) releaae. (Yea in Column 13 of the <br /> Inventory Reconciliation Sheet) 1 ' <br /> List datew tank ft and amount for all variations that exceeded the <br /> allowable limits. <br /> Datc Tank I Amount <br /> 2. <br /> 1. <br /> 4. <br /> S. <br /> Additiooal daces/amour(., chalL be continued ou a separate sheet of <br /> Paper and aCCachcd. <br /> Lf the Source of Chc variation -h,ch e<cc_cded alluw ble limits w s due (o <br /> • leak the knckden( shall be reported to S . .J 1, 11 [) . Envk ronmen(aL Ilea I <br /> wkchkn 14 hourt and an unau(horeport •ubmktted. <br /> the q-arterly .m ry report shall be c..bmi((cd vichkn IS days of (he end of each <br /> quar (�r <br /> Quarter I - January <br /> Quarter 7 - April --> Jane <br /> Quarter I - July --) is p(r•mhrr <br /> Q�,artcr G - October --> D,. ccmhcr <br /> Send co: SAN JOAQUIN LOCAL HEA0i; DISI HIC'1' <br /> 1601 K . I:az( I I u1 , P . 0 Iio.Y M09 <br /> Stockton , (;A ' 5201 464 - 67b1 <br /> U(;1 40 10/ K6 <br />