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INVENTORY RECONCILIATION <br />VED <br />QUARTERLY SUMMARY REPORT FORM APR 15 1gg1 <br />ENNIRONMt NTAL HEALT <br />Facility Name: /� <br />< MWA <br />Fac. ity Addresssx. <br />Telephone: 9Sa_ <br />Person F ling -- <br />Report <br />ElI hereby certify under penalty of perjury that all inventory variations fo <br />the above mentioned facility were within the allowable limits for this r <br />quarter. (No in Column 13 of the Inventory Reconciliation Sheet) <br />ETI"Invencory variations exceeded the allowable Limits <br />for this quarter. I <br />hereby certify under <br />penalty of perjury that the source for the variation <br />was not due to an unauthorized (leak) release. (Yes in Coles 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank i, and amount for all vari <br />allowable limits. aCioas that exceeded the <br />Date Tank / <br />Ar�ouII t <br />1. <br />z _ - <br />3. <br />4. <br />S. <br />Additional dates/amouats shall be contiaued oo a <br />Paper and attached. separate sheet of <br />If the source of the variation which exceeded allowable limits was due to <br />leak the incident shall be reported to $ <br />Within 2�. ho.J.L.If. D. Environmental EEealth <br />urs and an unauthorized release report submitted. <br />The quarterly summary report shall bar .ubmi <br />quarr [ccd within IS '1.�ys of the end of c,�ch <br />cr. <br />Quarter I - January --) Harch <br />Q�iartcc 2 - April -_> Julle <br />�2uartec 3 - July <br />Q1+arter /. - October --> December <br />amend CO: <br />LICT 40 10/ 86 <br />SAN .JOAQUIN LOCAI. IIEAI.T'II DISTI:ICl' <br />1601 E. Ilazelton, I1.0. Box 2009 <br />Stockton, CA 95201 466-6781 <br />