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• • 4A <br /> INVENTORY RECONCILIATION ��� ZF g <br /> QUARTERLY SUMMARY REPORT FORM O,' <br /> Facility Name: Stockton Center Tank / Size roducc <br /> —9a •Unlea e <br /> Facility Address: 1804 W. Main Street <br /> Stockton, <br /> Telephone : (415) 465-3700 <br /> Person Filing <br /> Report Walter J. Bishop <br /> aI hereby certify under penalty of perjury that all inventory variations for <br /> the above meacioned facility were within the allowable limits for this <br /> quarter. (No in Column 11 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 as unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, sad amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> 1. <br /> 2- <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amouots 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 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 xubmi[[cd within 15 days of the end of each <br /> quarter. <br /> Quarter I - January --) March <br /> Qvartcr 2 - April --> June <br /> Quarter J - July --) Jep[emhrr <br /> Quarter 4 - October --) Occember <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E Laze l t 4�n . P . 0 , ho x 2009 <br /> S[ ockr.on , CA 95201 466 - 6751 <br /> lic;T 40 10/ 86 <br />