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INVENTORY RECONCILIATION � '1pJaGEOh5 <br /> � <br /> QUARTERLY SUMMARY REPORT FORM I�tS�J\ <br /> Facility Naaae: Stockton Center TM. SFacility Address: 1804 W. Main Streetunleaded <br /> Stoc ton, <br /> Telephone : (415) 465-3700 <br /> Person Filing <br /> Report Walter J. Bishop <br /> 0 I hereby certify under peaalty of perjury that all inventory variations for <br /> the above eeacioned facility were within the allowable limits for this <br /> quarter. (No is Column 13 of the Inventory 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 /> was not due to An uasuthorized (leak) release. (Yes in Colin 13 of the <br /> Inventory Reconciliation Sheer) <br /> List date; tank /, aad amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 1. <br /> 2. <br /> 3 <br /> ------------- <br /> 4. <br /> 5. <br /> Addir_iooal 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 toS .JL. H . D . Environmental Health <br /> . <br /> Within 24 hours. and an unauthorizcd release report submitted. <br /> The Quarterly suaaaa ry report shall be submitted within 15 days of the end of each <br /> Qutrtcr. <br /> Quarter I January --> March <br /> Quartcr 2 - April --> June <br /> arter-.J3 - Jul --) j <br /> Y c pCcmh.:r <br /> Quarter 4 - oc(ober --) rkcember <br /> Send to: SAN JOAQ111rN LOCAL HEALTH DISIRIC-1 <br /> 160 1 1' I aze I r ,,n . 11 . 0 Hox ),007 <br /> L1(;1 i.0 <br /> tiLOcb. t.on , CA 15201 466 -67bl <br /> 10/ H!, <br />