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FacLUty. Name: PUBLIC WORKS <br />ricilaty',Addre@d: 1810 E. HAZELTON <br />-STOCK'TON, CA 95205 _ <br />Telephone: _ (209) 468-3074 ._.. <br />Person Filing <br />Report JUNE OKUBO <br />0 L 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 l3 of the Inventory Reconciliation et) <br />X 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 an unauthorized (leak) release. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) ! . <br />List date, tank f® and amount for all variations that exceeded the <br />allowable limits. <br />LA <br />Date Tank f Amount` <br />1. 4-8-91 1 199 �o � <br />F' <br />2. 4-15-91 2 124 <br />3. 4-18-91 2 <br />139 ICES <br />4. 5-2-91 2 151 <br />S. 6-17-91 2 507 <br />6. 6-21-91 2, 133 <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 />At 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 15 days of the end of each <br />quarter. <br />Quarter 1 - January --) march <br />darter 2 - April --) June <br />Quarter 7 - July --) September <br />Quarter 4 - October --> December <br />Send to: SAN JOAQUIN LOCAL HEALI.11 D1S-1-RICT <br />1601 E. 11aze 1 t AHI . P.O. lacy 2009 <br />Stockton, CA 95201 466-67b1 <br />EH 23 019 10/86 <br />T <br />