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INVENtORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> ►agility Name: Port Stockton Food Dist Tank / <br /> Size Product <br /> rseility Address: 1 2000 Diesel <br /> _2001 F. Fremont <br /> __Stockton CA 95202 <br /> Telephone : 209-948-1814 <br /> Person Filing <br /> Report Randv Thomas <br /> hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> quarter. (No in Colu® IJ of the Inventory Reconciliation Sheet) <br /> ❑ Inventory varistioas 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 Lm unauthorized (leak) release. (Yes in Column IJ of the <br /> Inventory Reconciliation Sheet) _ <br /> List date. tank /, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> I. <br /> 2. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> Paper and attached. <br /> If the source of the variation which exceeded allowable limits was due to <br /> a leak the incident shall be reported toEnvironmental Ilcalth <br /> S -I . L . H . D . <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of Goch <br /> quartor, <br /> iJl <br /> Quart -r I - January --) March <br /> Q-jarter I - April --> June rr <br /> Quarter t - July --> september 0 - <br /> gjarter 4 - October --> Urcember 1% <br /> Send to: SAN JOAQUIN LOCAL IIEA1J-h 01511'111C'I' <br /> I <br /> 1401 E. . I!:1zi 11 ni , 11 0 ISn'•: 7110'1 <br /> St4)Ckton , CA 95201 4f,1, - 4 /bI <br /> ,h;'1' 4t) 111/ M0 <br />