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•'`RECONCILIATION <br />•M ;, SUMMARY REPORT •., <br />Facility Name: STC �or rM <br />Facility Address: Gl eh tr <br />Telephone: <br />Person Filing ®— <br />Report: /e - <br />I hereby certify under penalty of perjury that all inventory <br />variations for the above mentioned facility were within the <br />allowable limits for this quarter. (Lo_ in column 13 of the <br />Inventory Reconciliation Sheet.) <br />Inventory variations exceeded the allowable limits for this <br />quarter. I hereby certify under penalty of perjury that the <br />source for the variation was not due to authorized (leak) <br />release. (Yes in Column 13 of the Inventory Reconciliation <br />Sheet) . <br />List date, tank 1, amount for all variations and the reason <br />for exceeding the allowable limits. <br />ate a mou t Beason <br />I. 12- 22-`x/ /b?7 '2G,�f fur''Lu11 <br />2. tz -3o `( 1 1(' 7-7 --T—) 5-_? macc4:niic 0"P <br />3. <br />4. <br />5. <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 (4) 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 />Quarter 3 - 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 0 <br />