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r ♦ • <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Fatuity Name: <br />� SAW—,/ <br />E] 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 13 of the Inventory Reconciliation Sheet) <br />Inventory 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) releise. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, taak f, and amount for all variations that exceeded the <br />allowable limica. <br />Date Tank f Amount <br />1. <br />Z. <br />3. <br />4. <br />S. <br />Additional dates/amounts shall be continued on a separate sheet of <br />paper and attached. <br />Lf the source of the variation which -exceeded at -lovable limits was due to <br />a leak the incident shall be reported to S.J.L.H.D. Environmental 11calch <br />within 24 hours and an unauthorized release report submitted. <br />The quarterly summary report shall be submitted <br />within 15 days <br />of the end of each <br />quarter. <br />Qu..rter <br />1 - January --) March <br />Quarter <br />2 - April --> June <br />Quarter <br />3 - July --> September <br />Quarter <br />4 - Octobcr <br />Send Co: <br />SAN JOAQU IN LOCAL HEALTH <br />U i S'1'It 1 Ci' <br />1601 L. 1 ave 1 ton . P.O. <br />Box 2009 <br />A <br />SLockcon. CA 95201 <br />466-67b1 <br />UGT 40 10/86 <br />v..{t� <br />