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0 <br />r <br />* 0 <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility N. -C:°9 <br />Fac_ ity Address: <br />��•� cot � 4 Jc' 9 <br />Telephone: <br />Person Filing <br />Re p o r C 42 <br />kLwLii��ia� <br />JUL 1 1 1991 <br />❑ I 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 13of the Inventory Reconciliation Sheet) <br />Iaventor i <br />Y 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 />Last date, tank i, and amount for all variations that exceeded the <br />allowable limits. <br />Additional dates/amouats shall be continued on a separate sheet of <br />Paper and attached. <br />Lf the source of the variation which exceeded allowable limits was due to <br />a leak the incident shall be reported to <br />Within 24 hours and an unauthorif•nvi o <br />zed release report submEmental Health <br />I'hc quarterly summary report shall be .ubmi[ted within IS days of the end uE <br />qu�rf��r. <br />January --> March <br />�Q`1artcr 2` - April --> June <br />Quarter 3 - July --� SePtemher <br />Q„arter 4 - October --> December <br />�en<t 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 />Date <br />Tank # <br />Amount <br />1 . <br />5- b' - S/ <br />-1-3 /V <br />3. <br />4- <br />Additional dates/amouats shall be continued on a separate sheet of <br />Paper and attached. <br />Lf the source of the variation which exceeded allowable limits was due to <br />a leak the incident shall be reported to <br />Within 24 hours and an unauthorif•nvi o <br />zed release report submEmental Health <br />I'hc quarterly summary report shall be .ubmi[ted within IS days of the end uE <br />qu�rf��r. <br />January --> March <br />�Q`1artcr 2` - April --> June <br />Quarter 3 - July --� SePtemher <br />Q„arter 4 - October --> December <br />�en<t 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 />