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INVENTORY RECONCILIATIO <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: SAN JOAQUIN BEVERAGE INC Tank # Size Product <br /> Facility Address : 1245 W Weber Ave,Stockto 10' 000 Gasoline <br /> CA 3 + 000 Deisel <br /> Telephone: 948-9400 - <br /> Person <br /> 48 00Person Filing <br /> Report: Maida Olson <br /> I hereby certify under penalty of perjury that .all inventory variations <br /> Q for the above mentioned facility were within the allowable limits for <br /> this quarter. (No in Column 13 of the Inventory Reconciliation Sheet. ) <br /> F7 Inventory variations exceeded the allowable limits for this quarter . I <br /> hereby certify under penalty of perjury that the source for the varia- <br /> tion was not due to unauthorized ( leak) release. (Yes in Column 13 of <br /> the Inventory Reconciliation Sheet) . <br /> List date, tank # , and amount for all variations that exceeded <br /> the allowable limits . <br /> Date Tank # Amount <br /> 1 . <br /> 2 <br /> 3 . <br /> 4 . <br /> 5 . <br /> Additional dates/amounts shall be continued on a separate sheet <br /> paper and attached . <br /> If the source of the variation which exceeded allowable limits was <br /> due to a leak, the incident shall be reported to San Joaquin Local <br /> Health District; Environmental Health Division, within twenty-four <br /> ( 24 ) hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within fifteen ( 15 ) days <br /> of the end of each quarter. <br /> Quarter 1 - January---------->March <br /> Quarter 2 - April------------>June <br /> Quarter 3 - July------------->September Xle <br /> !Et <br /> r 4 <br /> October---------->December j <br /> Send to: SAN J©A1 UIN LOCAL CAL HEALTH DISTRICT <br /> 1601 E. Hazelton, P.O. Box 2009 <br /> Stockton, CA 95201 468-3420 .OtiM 0�9 j <br /> 'yip,F�ip 89 V <br /> Ell 23 019 10/86 <br />