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INVENTORY RECONCILIATION , <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Kinq Island Resort Tank A size Product <br /> Diesel 4 . 000 ��= 1 <br /> Facility Address: 11530 W . 8 Mlle Rd . <br /> Stockton , CA 95219 <br /> Telephone: ( 209) 951 -2188 <br /> Person Filing <br /> Report: Y\/nnnp Mahe, <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. (N2 in column 11 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. (ygl in Column 13 of the inventory Reconciliation <br /> Sheet) . <br /> List date, tank 0, amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> Date Tank l Amount Reason <br /> jo�tr ctouontedefo°r <br /> 1, 12/21 - 12/24 /91 Diesel -59 . 75 Ava . t t <br /> Temp . coodJe"d foor <br /> 2. 12/27- 12 /29 /91 Die-al -41 n Awn 12/'5u/ 91 <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 (24) hours and an unauthorized <br /> release report subwitted: <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 7 - _July ------------>September <br /> uarter 4 - atotler --------->Decembeer ) <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 />