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I <Zr-4 10/90 <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Name: e - <br />Facility Address: 6(O V 9 G �� zl't— <br />�� <br />Telephone : 9 . r-/ <br />Person Filing <br />Report C4, <br />'tank E size.Prad+ict <br />/ p, p+." ( <br />❑ I hereby certify under penalty of periury that all inventomr vier1_PC,.r,nn P -r <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 an unauthorized (leak) releise. (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 licnits. <br />Date <br />Tank I <br />Amount <br />2_ <br />(33.1 <br />3. <br />8 q. 7 <br />4. <br />G_3 <br />S- - <br />9. 7 <br />RECEIVED <br />J U L 1 61990 <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <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 />At leak the incident shall be reported to S.J.L.1i.D. Environmental Health <br />Within 24 hours and an unauthorized release report submitted. <br />The Quarterly summary report shall be Rubmitted within 15 days of the end of each <br />Quarter. <br />Quarter I - January --) March <br />Q'14rter 2 - April --> June <br />Quarter 3 - July --> Scptemh(-r <br />Quarter 4 - October --) I)Icember <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. llaze 1 c<+n . P.O. Box 2009 <br />Stockton, CA 95201 466-6781 <br />EH 23 019 10/86 <br />