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y INVENTORY RECOtlCILIAT [ON <br />QUARTERLY SUMMARY REPORT FORM <br />FaciliC7 Name ® l <br />Fac: iCy Address; <br />Telephone: <br />Person Fit' g <br />Report <br />Ir . <br />E L hereby certify under penalty of perjury that all inventory variations <br />the above mentioned facility were within the allowable limits for this for <br />quarter. (Ko in Column 13 of the in <br />Reconciliation Sheet) <br />011� <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) release. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank i, and amount for all variations <br />allowable lithat exceeded the <br />mits. <br />Date Tank I Amount <br />t. <br />2_ <br />3. <br />4. RECEIVEL) <br />5. <br />APR 15 199, <br />--- ENVIRONMENTAL HEALTH <br />Additional dates/amounts shall be continued oo = cepa tePERMIT/SERVIC S <br />Paper and attached. sheet 0 <br />If the source of the variation which exceeded allowable <br />a leak the incident shall be reported to limits was due to <br />Within 24 hours and an unauthorised rel lease J . . . D. Environmental llcalth <br />Thc quarterly sumaaary report shall b<r .ubmitted within IS days of the end <br />qu•'rc�•r. <br />of (,.1ch <br />Quarter I - January --> Narch <br />Quarter 2 April --> June <br />Quarter 3 - July --> =e`'[emher <br />(r,.zrter f. - October --> lk:cember <br />Sen�f <br />to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Itazelton, I.0. Box 2009 <br />UCT 40 10/86 Stockton, CA 95201 466-6781 <br />