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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Hine: - Tank i Size oducc <br /> Facility Address: 400 <br /> Telephone : <br /> Person F L <br /> Report <br /> I hereby certify under penalty of perjury that all inventory variations for <br /> the above aeacioned facility were within the allowable limits for this <br /> Quarter. (aro 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) release. (Yes in Colum 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank 1, and amount for all variations that exceeded the <br /> allowable litnita. <br /> Date Tank f Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> S. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which. excecded allowable limits was due to <br /> a leak the incident shall be rcporced co S .J .L.H . D . Environmental Ucalch <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly sucenacy report shall br Fubmitted within 15 days of the end of each <br /> Quarter. <br /> Qu=.rtcr I - January --> lurch <br /> Q'lartcr 2 - April June <br /> Quarcer 3 - July --> Scpccmh(!r , <br /> Quarcec 4 - October --> rltermber <br /> Scnd Co: SAN JOAQiU IN LOCAL HEALTH D I STIt I CT <br /> 160L E. Haze l t (,n . P .0 . ROM 2UO') <br /> SIockCOn . CA 05101 466 -67bl <br /> LJGT 40 10/ 80 <br />