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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM (MCT t6vv► J cde akva ) <br /> Facility Name : rj1- k lin' �; �'j Tank # Size Product <br /> I 2,ooC) _ <br /> Facility Address : lq3l n. EL P; <br /> Sto C_Kt a. 95305 <br /> Telephone: AZUR <br /> Person Filing <br /> Report: . Fr�av\�,-_- M c�v-a� ✓ <br /> I hereby certify under penalty of perjury that .all inventory variations <br /> ❑ for the above mentioned facility were within the allowable limits for <br /> this quarter. (No in Column 13 of the Inventory Reconciliation Sheet. ) <br /> Inventory variations exceeded the allowable limits for this quarter. I <br /> Q hereby certify under penalty of perjury that the source for the varia- <br /> tion was not due to unauthorized ( leak) release. (Yes in Column 13 of <br /> the Inventory Reconciliation Sheet) . <br /> List date, tank # , and amount for all variations that exceeded <br /> the allowable limits . <br /> Date Tank # Amount <br /> 1 . 1 - .2)-- yam � ��-� �a� . - - E35 . � 9 caokog5 <br /> 2 . a- i 90 -1a, 00o Cao.\ +- 13. '7 <br /> 9a11o� 5 <br /> 3 . 3 ` 1'A - ia UC)o ��t`. 4- <br /> 4 . 3 .U0o exa-. - <I71i�)o 9a11� � 5 <br /> 5 . 3-� C� - (� , oUo aaL .4 I ' a 3 q <br /> Additional dates/amounts shall be continued on a separate sheet <br /> paper and attached. <br /> If the source of the variation which exceeded allowable limits was <br /> due to a leak, the incident shall be reported to San Joaquin Local <br /> Health District; Environmental Health Division, within twenty-four <br /> ( 24 ) hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within fifteen ( 15 ) days <br /> of the end of each quarter. <br /> Quarter 1 - January----------->March <br /> Quarter 2 - April------------>June <br /> Quarter 3 - July------------->September <br /> Quarter 4 - October---------->December <br /> Send to: SAN JOAQUIN LOCM, HEALTH DISTRICT <br /> 1601 B. Hazelton, P.O. Box 2009 <br /> Stockton, CA 95201 468-3420 <br /> LII 23 019 10/86 <br />