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0 <br /> 1 <br /> 0 L jL <br /> INVENTORY RECOtICIL IATION <br /> 0 V <br /> QUARTERLY SUMMARY REPORT FORM <br /> OCT 17 <br /> Facility Name: ` <br /> _ Tan <br /> Product <br /> Fac. ity Address: <br /> Telephone : <br /> Person Filing <br /> Report n <br /> Q I hereby certify under penalty of perjury that all inventory <br /> the above mentioned facility were within the allowable limitsvfor3this <br /> s for <br /> quarter. (No in Column 13 of the lovencory Reconciliation Sheer) <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 an unauthorized (leak) release. (Yes in Column 13 of the <br /> Iovencory Reconciliation Sheet) e <br /> Last date, tank f, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank <br /> Ar Dunt <br /> 2- <br /> 4. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> Paper and attached. <br /> If the source of the variation which exceeded allowable <br /> a leak the incident shall be reported to limits was due to <br /> Within S .J .L. H. D. Environmental ticalCh <br /> 24 hours and an unauthorized r(-lease report submitted. <br /> me quarterly summary report shall ht! submitted within IS days of the end of r <br /> quarc�tr . <br /> ..�ch <br /> Quarter I - Jaaunry --> Narch <br /> Q•,jartcr 2 - April <br /> J"uTy`_ <br /> Q+,artcr 4 _._____ . <br /> October --> 1'h-cember <br /> Jen`' to: SAN .JOAQUIN LOCAL HEALTH DISTRICT' <br /> 1601 F. Hazelton , P . O . Box 2009 <br /> UCT 40 10/86 Stockton, CA 95201 466-6781 <br />