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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Ctncktnn Center Tank i Sice Pr duct <br /> Facility Address: 1804 West Main Street Unleaded <br /> Stockton , CA <br /> Telephone : (415) 465 - 3700 <br /> Person Filing <br /> Report Walter J. Bishop <br /> ® 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 13of the inventory Reconciliation Sheet) <br /> E] 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 as unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank t, and amount for all variations that exceeded the <br /> allowable limits_ <br /> Date Tank / Amount <br /> 1. <br /> 2. <br /> 3- <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation vhich. exceeded 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 mubmitted within 15 days of the end of each <br /> Quarter. <br /> Quarter I - January --) March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> Sepccmher <br /> Quarter 4 - Occober --) Occember <br /> Send to: SAN JOAQUIN LOCAL HEALTh DISTRICT <br /> 1601 1: _ hazelt (m , P .O . ho-, )0119 <br /> SLockt-on , CA 95201 466- 67bl <br /> U(;1- 40 10/ 86 <br />