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f . I.NVII-WORY R CONCILIATION JAN 1 '1 <br /> QUARTEs'RLY SUMMARY REPORT FORM VMONMl L HEALTH <br /> Fac.i. 1. i Ly Name: RMC LONESTAR '.yank N 5 )� r vss t <br /> ro uc <br /> 1 1 , 000 n ea de <br /> Facility Address : 303SO S. Tracy Blvd. 2 10 -000 Diesel <br /> r`fi acy= a• S 7� 000 Diesel _ 5 2 <br /> Person filing -- --- -- <br /> Repor"L : LLOYD S. BURNS <br /> I hereby certify under penalty of perjury that all inventory variations <br /> for the above mentioned facility were within the allowable lim.iLs for <br />! Lhis quarter. (No -in Column 1.3 of the Inventory Reconciliation Sheet. ) <br /> Inventory variations exceeded the allowable limits for this quarter. I <br /> r� hereby certify under penalty of perjury Lhat the source for the varia- <br /> (� Lion was not due to unauthorized ( leak ) release. (Yes in Column 13 of <br /> t-he Inventory Reconciliation Sheet ) . <br /> l.,ist da Le, tank 0 , and amount for all variations that exceeded <br /> the allowable limits . <br /> Date 'Tank # AmounL <br /> 1 . <br /> 2 . <br /> 3 . <br /> 4 . <br /> 5 . <br /> Additional dates,/amounLs shall be continued on a separate sheet <br /> Caper and attached . <br /> If the source of the variation which exceeded allowable limits was <br /> clue to a leak, the incident shall be reported to San Joaquin Local <br /> Ilcal-t-h District ; Lnvi_r.onmental Health Division,' within L-wenLy-four <br /> ( 24 ) hours and an unmithori zed release report subrni.tLed . <br /> The (Itim-. terl y summary report shall be submits-ed within fifteen ( 15 ) days <br /> of the end of cacti quarter . <br /> Quarter l - January----------->March <br /> r <br /> Quarter. 3 - July-------------->Scptember <br /> Quarto - OcLober----------->Decembe.r <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 160.1 T:. Hazelton, P.U. Box 2009 <br /> fLockton, CA 95201 468-3420 <br /> ATTEN': JAIME FAVILA <br /> 10/86 <br />