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1 <br />Facility Mame:, <br />Facility Address: <br />MEMO, 1� <br />INVENTORYRECONCILIATION <br />IT <br />QPARTERLY REPORT i, <br />tilA <br />- AN /i I <br />i- i� C'�oP/1110 OWN W— <br />■ 1 hereby certify under penalty of perjury that all inventory variations for <br />the above woencioued facility were within the allowable limits for this <br />quarter. (No. in coLumix 13 of the lovencocy Reconciliation Sheet) <br />Uj Inventory <br />underhereby certify <br />was not due to an unauthorized (leak) rele�se. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) I <br />List date, tack , and amount for all variations that exceeded the <br />" allowable Limits. RECEIVEV <br />Date rank 0 Amount L 1 <br />l ®6 1,7990 <br />ENVIRONMENTAL H LTr <br />z• <br />PERMIT/SERVICES <br />3. <br />4. <br />5. <br />Additional dates/amoucts shall be continued oo a separate sheet of <br />paper and attached. <br />If the source of the variation which. exceeded al-lowabte limits was due to <br />a leak the incident shall be reported to S . J . L . H . D . Env*ironmentaL tics! ch <br />WiChin 24 hours and an unauthorized release report submitted. <br />The quarterly summary report shall be submitted within 15 days of the end of each <br />quarter. <br />Quo rtcr 1 - January --> March <br />Quarter 2 - April --> June <br />Quarter 3 July --> Scptcmhrr <br />Quarter 4 - October --> oc cember <br />Send to: SAN JOAQU IN 1.0CA1. HEALTH DIS"1-R I CT ' <br />1601 E. Hazelton. P.O. Box 2009 <br />SLockcon. CA 95101 466-67bl <br />UGT 1-0 10/86 <br />