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Facility <br />Facility <br />Telepho <br />Person <br />Report <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />- e <br />tit <br />FEB 11989 <br />NVPERvil- <br />6 SEMCESLiH <br />(di <br />F <br />19 Z 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 />QInventory 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 />Inventory Reconciliation Sheet) <br />List date, tank #, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank I mount <br />t. <br />3. <br />4. <br />S. <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 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 />T <br />he quarterly su.=..ary report shall be submitted within 15 days of the end of each <br />quarter. <br />Quarter 1 - January --1 March <br />Quarter 2 - April --> June <br />Quarter 3 - July --> September <br />(!T!!!7 <br />uarter 4 - October December <br />Send to: SAN JOAQUIN' LOCAL H.;ALTH DISTRICT <br />1601 E. Hazelton, P.O. Box 2009 <br />Stockton, CA 95201 466-6781 <br />UGT 40 10/86 <br />