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atNVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />raciuty Name: F Am Licruorss Inc tank i Size. Product <br />Beg <br />facility 4ddress:1301 W. Kettleman Lane <br />I., <br />L a. Lodi, Ca . 95= 3 �� Pre <br />Telephone: (209) 334-3233 <br />Person Filing <br />Report I T?,srtna' <br />e <br />L hereby certify under penalty of perjury that all inventory variations for <br />the above mentioned facility were within the allowable limits for this <br />quarter. (No in Column13of the Inventory ReconciliationSheet) <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 % mautborixed (leak) releaser. (Yes in Column 13 of the <br />tave®tory Reconciliation Sheet) <br />List date@,tank it aed amount for all variations that exceeded the <br />allowable limits. <br />1. <br />2. <br />3. <br />4. <br />Date <br />Tank f <br />Amount <br />May 1987 <br />1 <br />May 1987 <br />May 1987 <br />Addit ooal dates/amoeots.shall 1* continued on it 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 toS ..T . L . H . D . Environmental Health <br />within 24 hours and an unauthorised release report submitted. <br />The quarterly summary report shall be submitted within 15 days of the end of each', ` <br />X <br />quarter. <br />Quarter I - January --> March <br />t� <br />Quarter 2 - April --> June <br />Quarter i - July --> September <br />Quarter 4 - October --> Occember <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Hazel<<ai. P.O. RO X 2009 <br />Stockton, CA 95201 466-67bl <br />OCT 40 10/86 <br />