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FaciLity Ham: Flame Liquors Inc <br />lacLlity,'Address: 1301 W. Kettleman Lane <br />' <br />Lodi. Calif. 95242 <br />Telephone: (209) 334-3233 <br />Person Filing <br />Report Pat raf f j gut <br />M <br />® I 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 Column 13of the Inventory Reconciliation Sheet) <br />Q Inventory variations exceeded the allowable limits for this quarter. 2 <br />hereby certify under penalty of perjury that the source for the variation <br />was not due to an unauthorised (leak) rale se. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List dates tank is and amount for aril varistioas that exceeded the # <br />allowable Iisuta. <br />Date Zack f Amount <br />I. June ;1987 1 0 <br />2. June 1987 2 ® e <br />3. June 1987 3 <br />4. <br />S. <br />Additional dates/amouots shall be continued on a separate she e%f <br />paper and attached. <br />If the source of the variation which -exceeded at-lowable limits was due to <br />a leak the incident shall be reported to S J , L. N , Q, 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 />quarter. <br />•. tea. <br />Quarter l - January --> March <br />Quarter 2 - April --> June <br />Quarter 3 - July --> September <br />Quarter 4 - October --> December <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 K. IlazetLoll. P.O. 110x 2009 <br />SLockton. CA 95201 466-6761 <br />LILT 40 10/86 <br />P <br />fkl, <br />,VIF C�e�l !�TAL LAL1+1 <br />t IT/SE VICLS <br />