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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Stockton Center Tank i Sire Product <br /> 1 1000- al . Unleaded <br /> Facility Address: 1804 W. Main Street <br /> _Stockton, CA <br /> Telephone : (415) 46r,_,7nn <br /> Person Filing <br /> Report Walter J. Bishop <br /> QX I 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 Column i3 of the Inventory Reconciliation Sheet) <br /> ElInventory 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 as unauthorized (leak) release. (Yes in Colo® 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank 1, and amount for all variations that exceeded the <br /> Allowable limits. <br /> Date Tank E Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional daces/amouots shall be continued on a separate sheet of <br /> paper and accacned_ <br /> If the source of the variation which. esceeded allowable limits was due to <br /> a leak the incident shall be reported to S _J _ L . H . D . Environmental Health <br /> within 24 hours and an unauthorized release report submitted. <br /> The Quarterly summary report shall be submitted within IS days of the end of each <br /> Quarter_ <br /> Quarter I - January --) H.irch <br /> Quarter 2 - April --> Jun, <br /> Quarter 3 - July --) scpCemhcr <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISIHICI <br /> 1001 L H;1zClt .uI . 1' . 0 . lion 2()119 <br /> Stockton , - CA 95201 466-67b1 <br /> Ut;1 /40 10/ 86 <br />