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Palo- 1 o� 2— <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM Nont6eirV , <br /> Facility Name: Stoc_k�ov\ Uh'.Ff e_a 56\00` Tank # Size JJ Product <br /> 'D:s����-t, Fac,'.►'.�'.�5 SgrViLe.S U i <br /> facility Address : j q3e a15 <br /> a 1�1, E tea\ �� . <br /> 5 t oc.;,c tam - <br /> Telephone: 9A 7-461 g 5 O 5 <br /> Person Filing <br /> Report: . Fha v-6< A , ►fpr o_ n <br /> I hereby certify under penalty of perjury that all inventory variations <br /> Q 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 /> 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 . 3_ oG UVI .+-3pAl Ca�l�� s <br /> 2 . �, ►q - `� C + 5a . OGaklov, (5 <br /> 3 . 3 -At- 'IO + `j) . 55 C,al�o� S <br /> 4 . 0 + �Iq -()a <br /> 5 . <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 LOCAL HEALTH DISTRICT <br /> 1601 H. Hazelton, P.O. Box 2009 <br /> Stockton, CA 95201 468-3420 <br /> LII 23 019 10/86 <br />