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INVENTORY. RECONCILIA <br /> QUARTERLY SUMMARY REPORORM <br /> Facility Name: Tank I Size Product <br /> Facility Address: o� <br /> Q <br /> Telephone: nAs AND GROC RY�Q---- <br /> %G <br /> Person Filing 2057 S.EL DORADO <br /> Report: STOCKTON(209)485.8210 <br /> I hereby certify under penalty of perjury that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quarter. ( To in" column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> Inventory variations exceeded the allowable •► <br /> quarter. I hereby certify under penalty ofR to ,h' <br /> source for the variation was not due to aut z "(leak) '"' <br /> release. (Yes in Column 13 of the Inventory R a2' LJ9,on <br /> Sheet) . ENVIRONMENTAL HEALTH <br /> List date, tank It amount for all variaMWJ/a" V&V reason <br /> for exceeding the allowable limits. <br /> Date Tank I Amount Rmsma <br /> 1. <br /> 2. <br /> 3. <br /> 4.- <br /> 5. <br /> Additional dates/amounts shall be continued on a separate <br /> sheet of paper and attached. <br /> If the source of the variation which exceeded allowable limits <br /> was due to a leak, the incident shall be reported to Public <br /> Health Services of San Joaquin County Environmental Health <br /> Division, within twenty-four (24) hours and an unauthorized <br /> release report submitted.- <br /> The <br /> ubmitted:The quarterly summary report shall be submitted within fifteen (15) days of <br /> the end of each <br /> f quarter. Circle appropriate quarter. <br /> �/ Quarter 1 - January--dig-L Lt->March (99'L- <br /> Quarter 2 - April ----------->June <br /> Quarter 3 - July ------------>September <br /> Quarter 4 - October --------->December <br /> Send to: SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENTVIRONMENTAL HEALTH DIVISION <br /> Stockton,�......-.��. , P.O. Box 2009c/Vc� ;N <br /> � Z CA 9 52 01 <br /> GAS AND GRt_.t`r7.: <br /> (209) 468-3420 2057 S.ELDri-% .,-,� <br /> • • STOCKTON <br />