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. a <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Faci_.l.i. Ly Name : RMC LONESTAR Tank # Size Product <br /> _0nIeadecL <br /> Facili.L-y Address : 30350 S. Tracy Blvd. 2 10, 000 Diesel <br /> racy, Ca. 9 376 5 71000 Diesel "562 <br /> Te.luphune: 209- 835-1 <br /> Person Filing <br /> Report : LLOYD S . BURNS <br /> [ hereby certify under penalty of perjury that all inventory variations <br /> F/I 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. <br /> hereby certify under penalty of perjury that the source for the varia- <br /> t-ion 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. . <br /> 2 . <br /> 3 . <br /> 4 . <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 /> clue 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 /> RECEIVEC, <br />� C,�- 111>,: i.I ------------------>.1une <br /> Quarter 3 - July------------->Septembe <br /> MIRONMENTAL HEALTH' <br /> Quarter 4 - October----------->December PERMIT/ -RVICESo <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton, P.O. Box 2009 <br /> Stockton, CA 95201 468-3420 <br /> CCS: 1149 <br /> ATTEN: JAIME FAVILA <br /> III 23 0113 1.0/86 <br />