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INVENTORY0 0 <br />RECONCILIATION <br />QUARTERLY <br />i ri REPORT <br />+•. FO <br />i <br />14 <br />Facility Name:�� + V V <br />j r <br />-�,M _ i <br />Person <br />Report <br />allowabletyo'l hereby certify under penalty of perjury that all inventory variations for <br />the above Wationed facility were within the <br />Inventoryquarter. (No in Column 13of the <br />, <br />Inventory variations exceeded the allowable limits for this quarter,.=l <br />hereby certify under penalty of perjury that the source for thevariation <br />was not due to an unauthorized (leak) release. (Yes in Col <br />umn Inventory Reconciliation Sheet) — i3 of the <br />List date® tank f, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank # Amount <br />r. <br />2. <br />3. <br />4. <br />5. <br />Additional dates/amounts shall be continued on a separate sheet of <br />paper and attached. <br />If the source of the variation which exceeded allowable limits was due to <br />a leak the incident shall be reported to $•J.L.H.D. Environmental Health <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 I - January --' March�/ Q q } ` <br />Quarter 2 - April --> June ! <br />Quarter 3- July --> September / <br />Quarter 4k--;, October --> December <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Hazelton, P.O. Box 2009 <br />UCT 40 10/86 Stockton, CA 95201 466-6781 <br />s�+"0� .. f1 $ . ..... f!. ��.... ! i r rye,`rww.n+,r.++0www..•`—w`.'.'«wdNs.t :YtMrHa:' ro s.!•: ff.� yy �� �q ' <br />'�,1 •}s.9!m..eM..Y .. _ ^Y���I�T"•fuif.� N. Picea.-i.1t4 .f'.•4 <br />