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VIN <br /> YENTORY RECONCILIATION 7/��;(� <br /> QUARTERLY SUMMARY REPORT FORM r <br /> Facility Name: 411011 . Tank i Size. Product <br /> Pacilit Address: - m t <br /> Telephone : <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 /> ElInventory variations 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 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 f Amount <br /> 1. <br /> 3. <br /> J U L 0 7 1992 <br /> 4. ENVIRONMENTAL HEALTH <br /> 5' PERMIT/SERVICES <br /> Additional dates/amounts &hall be continued on a separate sheet of <br /> paper .and attached. <br /> If the source of the variation which. exceeded a1'lov3ble limits was due to <br /> a leak the incident shall be reported to S .J .L.H . D. Environmental Health t� <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be Rubmitted vithin 15 days of the end of each <br /> quarter. <br /> Quarter 1 - Jaauary --> March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> septemhi-r <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEAL1'1i DISTRICT <br /> 1601 E. Ilaze 1<<►n . P .O . Box 2009 <br /> Stockton , CA 95201 466-6761 <br /> LH 23 019 10/86 <br />