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, <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FOICf 16 `41 <br /> ENVIRO,r4N;EN AL ,_ii";bi-T' <br /> Facility Name: Product <br /> Fkcility','Address: <br /> _. d , <br /> Telephone : %S'P� 3 J <br /> Person Filing � <br /> Report w e, <br /> ElI 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 /> Inventory 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 unauthorised (leak) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank to and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> 1. 71-311.,9z •�-• 9 <br /> 2. dAZ 6 <br /> 3. 9 3 i f it 7 <br /> 4. -712 Z z t3Z . f <br /> Additional dates/amounts shall be continued on a separate 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. <br /> Quarter I - January --) March <br /> Qjarter 2 - April --> June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --> December <br /> Send co: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Haze 1 Loll , P .O . BOX 2009 <br /> Seockton . CA 95201 466-6761 <br /> EH 23 019 10/86 <br />