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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: King Island R .sort Tank I size Product <br /> Facility Address: 11530 W. Eiaht Mile Rd _ <br /> ltn�kt= rrn 9,?1/ <br /> i <br /> Telephone: (209) 951-2188 <br /> Person Filing <br /> Report: vypnnp MaheP <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. ( ]2 in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> [-,4 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 f, amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> Date Tank Amount Reason <br /> Dipstick misread <br /> 1. 9/6 & 9/7/91 Reaular -77 dS acrnunterl fnr 9/8/91 <br /> -69.9 Meter reading incorr- <br /> 2. 9/9-9/11 /91 P"'lar 9-(A,,g ) + nrrt 'o 1/12/91 <br /> Meter reading incorr- <br /> 3 . 9/15-9/21/91 Regcc <br /> Regular -100.0 (Avg-) emit At fnr 9/22/91 <br /> +151 .86(Av ) Gas expansion due to <br /> 4 . 9/23-9/28/91 �L. tem7Pr=t,o <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 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 gg' <br /> Send to: SAN JOAQUIN PUBLIC HEALTH SERVICES OCT ) ) 1991 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> " 1601 E. Hazelton Ave. , P.O. sox 2009 ;VIRONMENTA! HEALTH <br /> Stockton, CA 95201 � Rn�iT!SERVICES <br /> (209) 468-3420 <br />