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:r <br /> INVENTORY RECONCILIATIOM R,7" <br /> QUARTERLY SUMMARY REPORT FORM APR 0 1 1 93 <br /> ENVIRONIMENTAL HEALTH <br /> Facility Name: Pr MIT/ ERVICLS <br /> Product <br /> —2 C- Tank F Size Product <br /> Sir <br /> Facility�Address: 106) rC 4 <br /> e,7,9 X7 V117 77 <br /> Telephone : Lrc/ <br /> Per0on Filing <br /> Report <br /> I 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. (No in Column 13 of the Inventory Reconciliation sheet) <br /> ElInventory 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 40 unauthorized (Leak) relea' se. (Yes in COlumn13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank t, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional daces/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> if the source of the variation which- exceeded al-lowable limits was due to <br /> a Leak the 'incident shall be reported to S .J . L. H . D. Environmental Health <br /> within 24 hours and an unauthorized release report subm' <br /> tcced. <br /> The quarterly summiry report shall be Aubmitted within 15 days of the end of each <br /> quarter. <br /> Quarter I - January March <br /> Q,jartcr 2 - April June <br /> Quarter 3 - July SePCemher <br /> Q'iarter 4 - OcEobcr December <br /> Send CO: SAN JOAQUIN LOCAL HEALT]i DISTRICT <br /> 1601 1_ faze l ( cul . p . O . 1�()x 2()()g <br /> SLockLon . CA 95201 466 -67b1 <br />;T r,0 <br />