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F►iBSHEARS CHEVRON • R E R " <br /> PHONE: 8223-5717#33tily 4 <br /> 824 EAST YOSEMITE AVEN INVENTORY RECONCILIATION <br /> WANTECA, CALIFORNIA 95sY�ARTERLI SUHHART REPORT FORH APR 3 1941 <br /> ENVIRONMENTAL HEALTH <br /> racilLty Naj*SHEARS CHEVRON #3-3823 <br /> Tang / Sace <br /> _ Product <br /> Facility Add <br /> ST YOSEMITE AVENUE 1 7 <br /> Telephone : <br /> Person Fil�i g� � � <br /> Report � cx f�,-Z _- <br /> hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable li,ita for this <br /> quarter. (No is CoLu: 13of the lnvcntory Reconciliation Sheet) <br /> Elloventory variatious exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation i <br /> waa Got due to an unauthorized (leak) release. (yes in Column 13 of the <br /> I Inventory Reconciliation Sheet) r <br /> List date, tank I, and anount for all variatioas that exceeded the ' <br /> allowable limits- <br /> Date Tank I Amount <br /> 1. <br /> 2. <br /> k. <br /> S. <br /> Addit(oeal dztea/aamuota shall be continued on a separate sheet of <br /> papr tnd at(acthcd. <br /> If the source of the variation ..h-ch c<cecded al luwb le Iimi to vas dc to <br /> a Ieak the incidcn( mall be reported to S .J . L . H . D . Environmen(al 11calth <br /> wi(hin 24 hours and an una.,thortc,<d release report submic(cd. <br /> n1c avJrterly sua ry report shall b< a.,bmitt,d uithtn IS days of the end of each <br /> Quar(cr 1 - January --) March <br /> Quarter 2 - Apr iI --> Jun.: <br /> Quarter I - July __) jcptemher <br /> Q„artc 4 - October --) llkcrmber <br /> Send to: SAN JOAQUIN LOCAL HEA1.1G DISTRICT <br /> 1601 E . Ilazellt,n , P .O )tint '1.011') <br /> :ilocktan . C:A 115201 4G6-G1b1 <br /> 111:1' <br /> 40 10/H6 <br />