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INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />FaciLity Name: Flame L.iawrs Inc <br />Facility Address: 1301 W. Kettleman Lane <br />LiAdl rn1 i f 95240 <br />Telephone: (209) 334-3233 <br />Person Filing <br />Report K Pete Graffigna <br />ENVIROVIE.NTAL HEALTH <br />FFRMI I /SERVICES <br />Tank i Size. Product <br />1 Re <br />2� - Un.Lead Reg <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 13 of the Inventory Reconciliation Sheet) <br />0 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 as unauthorized (leak) release. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank %, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank E Amount <br />t - Mar 87 1 <br />2. Mar 87 2 <br />3. Mar 87 3 <br />4. <br />5. <br />Additional dates/amounts shall be continued no 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 S.J.L.H.D. Environmental Ucalth <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 --> March <br />Quarter 2 - April --> June <br />Quarter 3 - July --> September <br />Quarter 4 - October --> December <br />Send to: SAN JOAQUIN LOCAL HEALTIi DISTVICT <br />1601 E. Iiaze l L <ni , P.O. ROX 2009 <br />Stockton, CA 95201 466-6761 <br />Ut,T 40 10/86 <br />