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INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Nava:VPAh1ST,-)D kob c1zT,4 <br />Facility Address: QQ D <br />Telephone: 7 5 <br />Person��ili2)Q <br />� <br />Report ��tuff Q <br />APR 1 ? 1989 <br />I hereby certify unJer penalty of perjury that all inventory variations for <br />the above mentioned facility were within the allowable limits for this <br />quarter. (No in Colum 13 of the Inventory Reconciliation Sheet) <br />Inventory variations exceeded the allowable'limits for this quarter. I <br />b►ereby, certify under penalty of perjury that the source for the variation - <br />vas not due to an unauthorised (leak) release. (Yes in Column 13 of the <br />ftvsntory Reconciliation Sheet) . <br />List date; tank ip and amount for all variations that exceeded the <br />allowable- IL* its. <br />Date Tom! Amomt <br />2. <br />3 I -9-2-r, <br />S.. 89 <br />_......... <br />Additional dates/amoucts shall be continued on 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 cepocted.to' S,J.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 />• gwrter. . <br />Quarter I - January --> March <br />Quarter Z - April --> June <br />Quartet 3 - July --> September <br />Quarter 4 - October --> December <br />Send to: SAN JOAQUIN LOCAL. HEALTH DISTNCT <br />1601 E. Hazelto6.-P-0. Box 2009 <br />Stockton, CA 95201 466-6781 <br />UGT 40 10/86 <br />