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1 , <br />INVENTORY RECONCILIATION' <br />QUARTERLY SUMMARY REPORT FORM <br />t_"440" J, ..-'TARLTti <br />Facility Name: Flame Liquors Inc <br />Facility Address: 1301 W. Kettleman Lan <br />Telephone: (209) 292 334-3233 <br />Person Filing <br />Report Pete Graffigna <br />a <br />1 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 />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 so unauthorized (leak) releise. (Yes- in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank f, and amount for all variations that exceeded the <br />allowable limits. <br />FebDate Tank F Amount <br />87 2 <br />4. <br />5. <br />/Additional dates/amounts shall be continued on a separate sheet of <br />paper snd 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 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 1 - January --> March <br />Quarter 2 - April --> June <br />Quarter , - July --> September <br />Quarter 4 - October --> Occember <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 L. iiaze l t oll , P.O. BOX 2009 <br />Stockton, CA 95201 466-6761 <br />UCT 40 10/86 <br />