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INV-NTORY RECONCILI_kTION' r <br /> SUbLM-kRY REPORT :OARK <br /> An�vo/y <br /> Facility Name: 1 <br /> t Tank � r S� �a r �,-nr-li1Cr <br /> Facility Address: <br /> Telephone: <br /> Person Filing <br /> Report: <br /> QI hereby certify under penalty, of perjury that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quarter. (Na in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> Inventory variations exceeded the allowable limits for this <br /> t <br /> quarter. I hereby certify under penalty of perjury that the <br /> source for the variation was not due to authorized (leak) <br /> release. (Yes in Column 13 of the Inventory Reconciliation <br /> Sheet) . <br /> List date, tank t, amount for all variations and the reason <br /> for exceeding the allowable I'*`, ,- <br /> Date Tank amount Reason <br /> 2 . <br /> U <br /> 4 : <br /> Additional dates/amounts shall be. continued on a sena,ata <br /> sheet of •gape: and attached. <br /> If the source of the variation which exceeded allowable limits <br /> was due to a leak, the incident shall be reported to Public <br /> Health Services of San Joaquin County. =nv*ronmental Health <br /> Division, within •twenty-+four (24) hours and an unauthorized <br /> release report submitted. <br /> The quarterly summary report shall be submitted within fi=teen (LS)' days of <br /> the end of each qua_--ter. Circle appropriate quarter. <br /> Quarter 1 - January ------->March <br /> Quarter 2 - April ---------->June <br /> Qua-ter 3 - July ------------>Seatember - <br /> Quarter 4 - October --------->Decamber - -- ._ - <br /> ^`end <br /> to: SAY JOAQUIN COUNTY PUBLIC KMA2TH SERVICES <br /> F_NVIR0Nb.7_NTAL HErkL,T:i DIVISSON . <br /> :... 1001 E. Hazelton Ave: , P.O.- Bcx 2008 <br /> ..- .. Stockton, CA 95202-. --- <br /> --`: 23 019 ('x0/89) <br /> (2 09) 468-3420 <br />