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SSHEARS CHEVRON <br /> PHONE: 823- #33823 <br /> INVENTORY RECONCILIATION 824 EAST yOS 5717 <br /> QUARTERLY SUMMARY REPORT FORMnrANTE -4. CSI ORNIAV NTJ <br /> 36 <br /> FaciiLty mane: BRESHSARS CHEynn„, Tank <br /> site Product <br /> —� IONE: 823-5717 <br /> 11 <br /> Facility Address: 824 EAST YOSEMITE e1rv„ p r <br /> ! ,r ,' <br /> Telephone : y <br /> Person Filin - n /� <br /> Reportop �at� <br /> QL 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 Colum 13of the laveatory 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 variscion <br /> was not due to as uanuthorixed (leak) rel"se. (Yes in Colum IJ of the <br /> Inventory Reconciliation Sheec) I <br /> List date. tank /a and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 1. <br /> 2. <br /> 4. <br /> 5. <br /> Additioaal dates/amounts shall be continued on a separate sheet of <br /> Paper and attached. <br /> if (he source of the variationvlu h ca _ <br /> e <eeded alluw ble lim,(s w s due to <br /> • leak the (ncsdent shall be repor (cd to S .J L . H . D . Environmental Ilea lth <br /> Within 24 hours and an unau(hor,[ed rcicase report submit[ed. <br /> the Quarterly sumoarl. report shall be A„bm,tted vith(n IS days oI the end of each <br /> Quarter . <br /> Quarter I - January <br /> Q•sartcr 2 - April <br /> Quarter ) - July --> Sep(emhcr <br /> Q,u Cter 4 - October r 'AA <br /> Send co: SAN JOAQUIN LOCA. HEAL'I'li DIS'fKICT <br /> ✓a <br /> 1601 E . vazell ,Hl , I' . 0 I)ns 211(1'1 <br /> iJ t. <br /> h0 IO/ H6 Stockton . CA '15201 466-67h1 p ME�ZPw ko <br /> 111:1' <br /> ENVE ERt���15ER <br />