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Facility <br />INVENTORYi <br />QUARTERLY SUMMARY O <br />Name: rk.4AIK6LOQ Fbab_ 'q <br />Facility Address: <br />Report:Person Filing &5- q5 75 - <br />I hereby certify under penalty of perjury that all inventory <br />variations for the above mentioned facility were within the <br />allowable limits for this quaErter. (No in column 13 of the <br />Inventory Reconciliation Sheet.) <br />Inventory variations exceeded the allowable limits for this <br />quarter. I hereby certify under penalty of perjury that the <br />source for the variation was not due to authorized (leak) <br />. ( es in Column 13 of the Inventory Reconciliation <br />1992List date, tank 1, amount for all variations and the reason <br />E VIRONNA NTAL H kfxceeding the allowable limits. <br />PERMIT SE VICES U <br />mou t EAU -on <br />3. /®67'2`7/ <br />4.-_/a® -/ <br />5. 11- 9 - ql <br />4 1/ <br />C- oL Lora <br />Additional dates/amounts shall be continued on a separate <br />sheet of paper and attached. <br />If the source of the variation which exceeded allowable limits <br />was due to a leak, the incident shall be reported to Public <br />Health Services of San Joaquin County Environmental Health <br />Division, within twenty-four (24) hours and an unauthorized <br />release report submitted. <br />The quarterly summary report shall be submitted within fifteen (15) days of <br />the end of each quarter. Circle appropriate 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 COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />1601 E. Hazelton Ave., P.O. Box 2009 <br />Stockton, CA 95201 <br />EH 23 019 (10/89) (209) 468-3420 <br />