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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: _ L '^I �f1 Tank I Sue Produet <br /> Faeility Address: --w� <br /> Telephone : <br /> Person Filin 6n, <br /> /'\ '' a4` d�� 1 � <br /> Report /j R �- (�roM—PP <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 /> quactec. (No in Colum 13 of the Inventory Reconciliation Sheet) <br /> ❑ Inventory variation• 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 as unauthorised (leak) releiae. (Yes in Colum 13 of the <br /> Inventory Reconciliation Sheec) I <br /> List date. tank /, and amount for all variatioas that exceeded the <br /> allowable linin. <br /> 1. Date Tank I Amount RPM <br /> 2. APR <br /> 1. ENVIROMENTAL HEALTH <br /> PERMIT/SERVICES <br /> 4. <br /> S. <br /> AdditioaaL dates/amounts shall be contiaucd oa ■ separate sheet of <br /> Paper and aCtached. <br /> Lf Che source of Cho variation vhlch esceede.d allow ble limsCs as due Co <br /> a leak the incsdcnC shall be rcporer.l (n S . J I, . H D . Environmental IlcalCh <br /> within 24 hours and an ,naothor . ud release rcporC submiCCed- <br /> ITe q..arCerly s-umnu ry rcporC shall he so bmiCted viCh in 15 days of Che end of e.1 ch <br /> quarter <br /> QuarCcr I - January --> h.1"h <br /> �i aster 2 - AprLl Jun.- <br /> Quarter ) - July --) Septemhor <br /> Q11arter 4 - October <br /> Send Co: SAN JOAQUIN LOCAl. HEALl'li DISIHICT <br /> 1601 L: . Hazc 11 nn • P .0 Ros 2(H17 <br /> Slockcon . (.A 95201 460 - 61bl <br /> UC 1' <O IO/ H6 <br />