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(NVENtORY RECONCILIATION v <br /> QUARTERLY SUMMARY REPORT FORM <br /> facility Name; Port Stockton Food Dist <br /> Tank / Size Product <br /> Facility Address: 2001 E. Fremont 1 2000 Diesel <br /> Stockton, CA 95202 <br /> Telephone : 209-948-1814 <br /> Person Filing <br /> Report Randy Thomas <br /> QI 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 Column I]of the loventory Reconciliation sheet) <br /> ❑ Inventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under Penalty of perjury that the source for the variation <br /> vas not dLe to in unauthorized (leak) release. (Yes in Coles 17 of the <br /> Inventory Reconciliation Sheec) <br /> List dater tank to and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> I. <br /> 2. <br /> J. <br /> 4, <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 to S . .1 . 1. . H . D . Environmental Ilcalth <br /> within 24 hours and an unauthorized release report submitted. <br /> i <br /> The quarterly su—ry report shall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter I - January <br /> Q•urter 2 - April --) June rr <br /> Quarter 1 - July --> Septrmher 0 <br /> Q�,arter 4 - October --) tkcember 1% <br /> Send to: SAN .l0AQl1In IJl(:nl. HEA1.1'I. U1 :;'Ilttt:'I' <br /> 1401 E. I!;tzplt nt , I' . 0 h":-: ]IU14 <br /> Stockton , rn 95201 466 - 61b1 <br /> lot) III/ Mlt <br /> i . <br />