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INVENTORY RECONCILZATIaN <br /> =_° Y SUb24_ARY RMPORT FOR..., - <br /> r acility Name: Tank o,- <br /> dLC � <br /> Facility Address: <br /> I I <br /> .'Telephone: <br /> Person Filing <br /> Report: <br /> QI hereby certify under penalty- of peri u_-y that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quarter. (No in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> (� <br /> Inventory variations exceeded the allowable Limits for this <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 , amount for all variations and the reason <br /> for exceeding the allowable bi,_s. <br /> Tank Date 'T' ;mount Reason <br /> cz: IC <br /> 4 : <br /> 5. <br /> Additional dates/amounts shall be- continued on a sema=ate <br /> Sheet of '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 Services of San Joaquin County Z*nvironmental Health <br /> Division, within twenty-_our (24) hours and an unauthorized <br /> release report submitted, <br /> The cruarterly summa-y report shall be submitted within fifteen (15) days of <br /> the end of each quarter.quarter. Ci <br /> rcle appropriate qua,�er <br /> Quarter 1 - <br /> Quart ter 2 - April ----------->,Tune <br /> Quarter 3 - July ------------>Sentember <br /> Quarter 4 - October --------- <br /> camber _ <br /> d to : SAY JOAQUIN COUNTY PUBLIC ITIZA LT:l SERVICES <br /> 4 - <br /> `� ENVT_RONM.=.NTAL HMAZT:: DTVIS-TON <br /> 1.601 Z. Hazelton Ave., P.O. Box 2009 <br /> Stockton, CA 95201. - <br /> (209) 468-3420 - <br /> r"i 22 019 (10/89) , <br />