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INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT OR <br />T < <br />I hereby certify undernalt of r' <br />pe 7 perjury that all inventory variations for <br />the above mentioned facility were within the allowable limits for this <br />quarter. (No is Column 13 of the Inventory Reconciliation sheet) <br />Inventory variations exceeded the allowable limits for this quarter. I <br />hereby certify under penalty of perjury that the source for the variation <br />was not due to an unauthorised (leak) release. (Yes in Col 13 of the <br />Inventory Reconciliation sheet) <br />List date# tank #, and amount for all variations that exceeded the <br />allowable limits. <br />Date lank Amount <br />1. <br />2. <br />3. <br />4. <br />S. <br />Additional dates/amounts shall be continued on a separate sheet of <br />paper and attached. <br />If the source of the variation whiich.exceeded al'lowabte limits was due to <br />a leak the incident shall be reported to S.J.L.H.D. Environmental Heatth <br />within 24 hours and an unauthorized release report submitted. <br />The quarterly summary report shall be submitted within 15 days of the end of each <br />quarter. <br />Quarter 1 - January --1 March <br />Quarter 2 - April --> June <br />Quarter 3 - July --> September <br />Quarter 4 - October --> Qecember <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Hazelton. P.O. Box 2009 <br />JCT 40 10I86 Stockton. CA 95201 466-6781 <br />