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Q*NTORY.RECONCILIATION 00 <br />ERLY SUMMARY REPORT FORM <br />Facility Name: cr ralnn <br />Facility Address: <br />Telephone: <br />Person Filing <br />Report: <br />I hereby certify under penalty of perjury that all inventory <br />variations for the above mentioned facility were <br />*F90VED <br />allowable limits for this quarter. (F—o in col <br />Inventory Reconciliation Sheet.) <br />AV .9 1992 <br />Inventory variations exceeded the allowable limits foJr is <br />quarter. I hereby certify under penalty of peE HEALTH <br />source for the variation was not due to authorizedPEMOOERVICES <br />release. (Yes in Column 13 of the Inventory Reconciliation <br />Sheet). <br />List date, tank 1, <br />for exceeding the <br />2./0-/L/-9/ <br />3. <br />4. <br />5.11-5-171 <br />amount for all variations and the reason <br />allowable limits. <br />Tank -1 <br />4.7 7 <br />-7 7 <br />77 <br />/6-77 <br />1677 <br />A_mount <br />t X06 <br />Additional dates/amounts shall be continued on a separate <br />sheet of paper and attached. <br />If the source of the variation which exceeded allowable limits <br />was due to a leak, the incident shall be reported to Public <br />Health Services of San Joaquin County Environmental Health <br />Division, within twenty-four (24) hours and an unauthorized <br />release report submitted. <br />The quarterly summary report shall be submitted within fifteen (15) days of <br />the end of each quarter. Circle appropriate quarter. <br />Quarter 1 - January ---------- >March <br />Quarter 2 - April ----------- >June <br />Quart <br />July ------------ >September <br />Quarter �_4 - October --------- >December <br />Send to: SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />1601 E. Hazelton Ave., P.O. Box 2009 <br />Stockton, CA 95201 <br />(209) 468-3420 <br />0 <br />