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INVENTORY RECONCILIATION <br />h *4 Q*TERLY SUMMARY REPORT FORIP <br />Facility Address: <br />/NuOW <br />Telephone: <br />Person <br />Report <br />hereby, <br />variationsalty of perjury that all inventory variations for <br />the above mcationed facility were within the allowable limits for this <br />quarter. (NO, in Column 13 of the Inventory Reconciliation Sheet) <br />1ZInventory <br />hereby certify under penalty of perjury <br />. <br />t the source for the variation <br />was not due to an unauthorized <br />Inventory Reconciliation Sheet) <br />List date, tank 1, and amount for all variations that exceeded the <br />allowable litnits. <br />Date Tank f Amount <br />2. <br />9 <br />M <br />RP <br />Additional dates/amount` shall be continued on a separate sheet of <br />paper and attached. <br />If the source of the variation which exceeded allowable limits -vas due to <br />a leak the incident shall be reported to S J L.H.D. Environmental health <br />rtithih 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 />Qu:.rter 1 - .January --' Mich <br />Quarter 2 - April --> ,u„e <br />Quarter 3 - .July --> Septemher <br />Quarter 4 October --> December <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT v <br />1601 E. Hazelton. P.O. Hom 2009 <br />D- �p <br />Stockton, CA 95201 466-67b1 <br />111;1' 40 10/86;� <br />