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i <br />or INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Name: ,i a S <br />Pac. ity Address: /• /-i el��rdl re <br />Telephone: �0 ? <br />Person Filing <br />Report <br />t, <br />L hereby certify underpenal <br />thty of perjury that all inventoe AvO ve mentioned facility were within (Kiry variations for <br />the allowable limits for this <br />qu ter_ o n ColumnI3 of the Inventory Reconciliation Sheet) <br />el", <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 f, and amount for all variations that exceeded the <br />allowable limits. <br />Date <br />Tank <br />A=uat <br />I. Y-;? / - 4 r <br />April <br />--> June <br />2- <br />July <br />--> Sepcembr_r <br />3.--+ <br />October <br />/a-3 <br />4- <br />z <br />— 9,;? <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 allowable limits was due to <br />a leak the incident shall be reported to S.J.L.H.D. Environmental Elealth <br />within 24 hours and an unauthorircd release report submitted. <br />The quarterly summary report shall be .ubmitted within IS days of the end of r;lctl <br />quarcer <br />Jena to: <br />IICT 40 10/86 <br />Qu,rCet ( - <br />January <br />March <br />darter 2 - <br />April <br />--> June <br />Quarter 3 - <br />July <br />--> Sepcembr_r <br />Q"arter 4 - <br />October <br />--> I?ecember <br />SAN .JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Hazelton, I'.0. Box 2009 <br />Stockton, CA 95201 466-6781 <br />