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I INVENTORY RECONCILIATIC�. <br />OMRTERLY SUMMARY REPORT F(GRM <br />Facility Name: CAT.TFORNTA HTr^-WAy pATgOT <br />Facility Address: 385 W. (3rantlina TrRd <br />- <br />Telephone <br />Calif_ 95776 <br />Telephone: _ (209) 835-8920 <br />Person Filing <br />Report: Kenneth W. Milligan L662 <br />aI 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. (No 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 #, amount for all variations and the reason <br />for exceeding the allowable limits. <br />Date <br />1. <br />2. <br />3. <br />4. <br />5. <br />Tank <br />Amount <br />Reason <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 />er 1 - January ---------- >March <br />Quarter 2 April ----------->June /`lyy <br />Quar er 3 - July ------------>September <br />Quarter 4 - October --------->December <br />Send to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />uu5 �'J. Snti Ju � �.�X <br />P.O. Box 2009 <br />Stockton, CA 95201 <br />(209) 468-3420 <br />EH 23 019 (10/89) i <br />.L <br />F- <br />:. <br />< nr <br />N <br />M <br />Lai L. <br />=:SZ <br />C" <br />Ji <br />� tu <br />X <br />O <br />Zca. <br />.-. k <br />Of LSLLA. <br />CL.�. <br />Z <br />W <br />List date, tank #, amount for all variations and the reason <br />for exceeding the allowable limits. <br />Date <br />1. <br />2. <br />3. <br />4. <br />5. <br />Tank <br />Amount <br />Reason <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 />er 1 - January ---------- >March <br />Quarter 2 April ----------->June /`lyy <br />Quar er 3 - July ------------>September <br />Quarter 4 - October --------->December <br />Send to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />uu5 �'J. Snti Ju � �.�X <br />P.O. Box 2009 <br />Stockton, CA 95201 <br />(209) 468-3420 <br />EH 23 019 (10/89) i <br />