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RECEIVEDrINVENTORY RECONCILIATION <br />Y 1 1991 <br />n QUARTERLY SUMMARY REPORT FORM ENVIRO NT L HEALTH <br />Facility Name: <br />r 12 <br />►� <br />1_ <br />WM0- <br />L hereby certify under penalty of perjury that all inventory variations for <br />the above meationed facility were within the allowable limits for this <br />quarter. (No is Columna 13 of the Inventory Reconciliation Sheet) <br />ElIaventory 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 f, and amounc for all variations that exceeded the <br />allowable limits. <br />Date Tank P Amount <br />i. <br />2. <br />3. <br />4. <br />Additional dates/acs shalt be continued on a separate sheet of <br />paper and attached. <br />Lf the source of the variation which. exceeded al-lowabte limits was du` to <br />a leak the ineideac shall be reported to S.J.L.H.D. 6avironmencal ticatch <br />within 24 hours and an unauthorized release report submicced. <br />The quarterly summary report shall be submitted within 15 days of the and of each <br />quarter. <br />Qu.:rcer 1 - January --) March <br />QBarcer 2 - April --) June <br />Quarter l - July --> September <br />Quarter 4 - October --) Ik:ccber <br />Send cc: SAN JOAQU IN LOCAL HEALTH U I S1'R i CT <br />160L E. l:aze 1 t on , P.O. Rox 2009 <br />Stockton. CA 95201 466-67b1 <br />t1t:T 1+0 10/86 <br />