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INVENTORY RECONCII,LATION <br /> —=Yr y SUMYA.RY REPORT Fab <br /> Facility Name: s I Iri,c- <br /> � Tank - <br /> �z;�F acility Adci:ess : <br /> "iTelephone: <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. ( in column ?3 of the <br /> Inventory Reconciliation Sheet. ) <br /> L.1 L <br /> Inventory variations exceeded the allowable limits for this <br /> qua_zer. I hereby certify under penalty of perjury that the <br /> source for the variation was not due .to authorized (leak) <br /> Sheet) . <br /> release. (Yes in Column 3.3 of the Inventory Reconciliation <br /> List date, tank t, amount for a1.1 variations and the reason <br /> for exceeding the allowable limits. <br /> Data Tank Amount Reason <br /> s. <br /> Additional dates/amounts shall be- continued on a sena:ate <br /> Sheet oi 'paper and attached. ` <br /> If the source of the variation which exceeded allowable bits <br /> was due to a leak, the incident shall be reported to Public <br /> Health Se_''vices of San Joaquin County. :nvi*-onmental Health <br /> Division, with.i.*i -troienty-fou <br /> release report submitted. r (24) hours and an unauthorized <br /> The quarterly summa_7Y report shall be submitted within fi-fteen (2.5) days of <br /> the end of each quarter. Circle appropriate quarter, <br /> Quarter I - Tanuazv >Mar,h <br /> Qua_r ter 2 - April ----------->June - -- <br /> Qua_tee- 3 - July -- ->September"' <br /> Quarte— 4 - October --------->Decamber - <br /> I\ _ L;nd to: SAN JaAQUIN COUNTYrPUBLTC Hz'�I.T:I S VIC. S - _ - <br /> -�' .*tViRONM.�...*ITAL HF.�LTX D�'VISION --• - = -_ _- - . <br /> 1501 E. Hazelton Ave:, P.O. Box 2009 -- - --- <br /> - . CA 95201 _ - <br /> L'i 23 019 (' 089) (209) 468-3420 <br />