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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORD <br /> Facility Name: SHAUGHNESSY CAR WASH Tank I Size <br /> Product <br /> Facility Address: 601 E. Miner Avenue 6 000 Re ta7.ar <br /> 2 12 000 super Un1. <br /> Stockton CA 95202 3 12 000 Re Un7. <br /> Telephone : ( 209 ) 465-2542 <br /> Person Filing <br /> Report Lila Billheimer <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. 000 in Columa 13of 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 /> via not due to an unauthorized (leak) release. (Yes in Column 0 of the <br /> Inveatory Reconciliation Sheet) <br /> List date, tank f, and amount for all variations that exceeded the . <br /> allowable limits_ <br /> Date Tank it Amount <br /> 2. <br /> F <br /> 3, <br /> 4. 001 15 €9 37 <br /> S- ENVIROMENTAL HEALTH <br /> FERMIT/SERVICES <br /> Additional dates/amouatt shall be continued on a separate sheet of <br /> paper .and attached. <br /> If the source of the variation which exceeded allowable limits was dui to <br /> leak the incident shall be reported to S J I, H Environmental licalth <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of cacti <br /> quarter. <br /> Quarter I - January --) Hirch <br /> iart 2 - 11 ril --> Jurle <br /> arter 3 - July septmo <br /> {,hurter 4 - October --) lkcembcr <br /> Send to: SAN JOAQUI.N LOCAL HEALTH DISTRICT <br /> 1601 K . l,aw i t ren , P . O . hox 2009 <br /> Kockton , CA 95201 466-601 <br /> KT 40 10/116 <br />