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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Ernie's General Store, Irc. Tank f <br /> Sire Product <br /> Faeilitr "dress: 12,00RPQ <br /> _4407 R. Waterloo Rd 2 <br /> _Stockton, CA 95205 <br /> Telephone : (209) 931-2850 Prem <br /> Person Fili _ <br /> Report �4_ <br /> Ernest P. Giannecchini, President <br /> QX 1 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 I1 of the Inventory Reconciliation Sheet) <br /> ElInventory variations exceeded the allowable limits for this Quarter. T <br /> hereby certify under penalty of perjury that the source for the variation <br /> was Got due to so unauthorized (leak) release. (Yes in Column 13 of the <br /> r , Inventory Reconciliation Sheet) <br /> List date, tank 1, and amount for all variation, that exceeded the <br /> allowable limits_ <br /> Date Tank / Amount <br /> 2. <br /> 1 IAS h�ALTH <br /> SPIVVi"W L'cEftVICtS <br /> 4, FERI�IT/- <br /> 5. <br /> AAditiooal dates/amouacs shall be continued oa a separate sheet of <br /> paper and actai.ched. <br /> if the source of Che variation which exceeded allowable limits as due to <br /> • leak the incident shall be rcporced to S .J . L . H . D . Environmental Ilcalch <br /> wrthin 24 hours and an unauthorited release report s-ubmieted. <br /> IT1c Quarterly sum.aary report shall be Rubmitted wichin 15 days of the end of cacti <br /> Quarter, <br /> Quarter 1 - January --> N.irch <br /> Quarter 2 - April --> J...... <br /> Quarter I - July --> septemher <br /> Q: a etre 4 - occober --) oecember <br /> Send to: SAN JOAQU Ity L1CA1. HEAL 'Tli U I S'I R I CT <br /> 1001 E . HazcllrIII , P . O . Ito.x 2009 <br /> Q) 10/ N6 Stockton . CA 95201 466 - 6761 <br /> Jt;T <br />