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11 <br />INVENTORY t ,, <br />QUARTERLY SUMMARY REPORT <br />FacLUty. Name: PUBLIC WORKS <br />Facility*-Addresd 1810 E. HAZELTON <br />g..e STOCKTO , <br />CX 95'2U5- <br />Telephone- (209) 468-3074 <br />Person Filing <br />Report June Okubo <br />Tank E Site <br />JL2QO- <br />Product <br />NO LEAD <br />' 12 00• <br />SUPER NO LE <br />ii�D 000 <br />DIESEL <br />R <br />I hereby certify under penalty, of perjury that all inventory variations for <br />the above mbentioued facility were within the allowable limits for this <br />Quarter. (No in Column I1 of the teventory Reconciliation et) <br />Inventory variations exceeded the allowable limits for thisquarter.' t <br />hereby certify under penalty of perjury that the source for the variation <br />was not due to as unauthorised (leak) release. (Yes in Colusm 13 of the <br />taveatory Reconciliation Sheet) e <br />List date, tank to, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank Amount <br />1. 3-17-92 2 168 <br />2. _1-�1-gZ 1 211 <br />3. <br />4. <br />S. <br />Additional dates/amounts 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 . N . 0 . EnvironuentaL Health <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 each <br />quarter. <br />Quarter 1 - January --' March <br />Quarter 2 - April --1► June <br />Quarter 3 - July --, September <br />Quarter 4 - October --> December <br />Send to: SAN JOAQUIN LOCAL NEALTIi DISTRICT <br />1601 E. liaze l tim . P.O. Kam 2009 <br />Stockton, CA 45201 466-67bl <br />Eli 23 019 10/86 <br />V <br />