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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Stockton Center lTxi <br /> MUun <br /> Facility Address. 1804 W. Main Street <br /> Stoc ton, <br /> Telephone : (415) 465-3700 <br /> Person Filing <br /> Report Walter J. Bishop <br /> QI hereby certify under penalty of perjury that all inventory variations for <br /> the above oeationed facilitT were within the allowable limits for this <br /> quarter. (No in Colu® 13 of the Inventory Reconciliation Sheet) <br /> Inventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify uader penalty of perjury that the aource for the variation <br /> was mot due to an unauthorized (leak) release. (Yes in Col— 13 of the <br /> Inveatory Reconciliation Sheet) <br /> List date, tank f, and :mount for all variations that exceeded the <br /> allowable limits_ <br /> Date Taak f Amount <br /> 1_ <br /> 2- <br /> 3. <br /> 4- <br /> 5. <br /> Additioaal daces/amouats shall be conciaued on a separate sheet of <br /> paper and acc,ached_ <br /> If the source of the variation which. exceeded allowable limits was due to <br /> A leak the incident shall be reported to S .J . L. H . D . Environmental 11calch <br /> Within 24 hours and an unauthorized release report submitted. <br /> the gwarcerly summary report shall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter I - January --) March <br /> Q'Jartcr 2 ' - April --> June <br /> Quarter 7 - July --> Sepcemher <br /> Qvartcr 4 - Oc(Obcr --) 1leccmbcr <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISI-HILI <br /> 1601 I- - I'.nzcll �ui , 11 _ O 80.e 2009 <br /> ock(,O . CA 95201 466 - 6Ibl <br /> UCI �'O 10/ 86 <br />