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INVENTORY RECONCILIATION <br />OCT it <br />QUARTERLY SUMMARY RF_POR I FORM``' 1`t <br />Facility Name: �e 'k <br />Fac icy Address: 532/ A/ ih, z�2 <br />ST�ch�• cA �L"�� i <br />Telephone: Z o -y- 'VZr ,ryg <br />Person Filing <br />Report <br />�. I hereby certify under penalty of perjury that all inventory variations <br />the above mentioned facility were within the allowable lim is for this for <br />quarter. (No in Column 13of the Inventory Reconciliation Sheet) <br />QIaventory 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 ao unauthorized (leak) release. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />Lis[ date, tank i, and amount for all variations that exceeded <br />allowable limits. [he <br />Date Tank I Amount <br />2- <br />3. -- <br />4. <br />S. <br />Additional dates/amounts shall be continued on a separate sheet of <br />Paper and attached. <br />If <br />the source of the variation which exceeded allowable li©its was due to <br />a leak the incident shall be reported to S.J.L.lI.D. Environc�ental Health <br />Within 24 hours and an unauthor"'el r-Olease report submi[tcd. <br />I'11c 'IuartcrLy summary report shall 1)4r :,ibcnittcd within IS Mays of the en(f of <br />q�•�rC��r. <br />Quarter 1 - January --) Narch <br />Q`lartcr 2 - April <br />Quarter 3 - July --> Scptcmb�-r <br />Q,Aartcr !. - OCCObcr --> 1)4-ccmbcr <br />end Co: )AN JOAQUIN LOCAs. HEALTH UIST'RIC1' <br />1601 F. Hazelton , J, . 0 (sox XOO9 <br />OCT 40 10/86 Stockton, CA 95201 466_6781 <br />