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INVENTORY i i <br />QUARTERLY <br />r SUMMARY REPORT it <br />Facility. Names PUBLIC WORKS <br />IrAci.latyzAddreads 1810 E. HAZELTON <br />r, A_STOGKTON, CA 95205 <br />Telephone: (2ng) 6hR-3074 <br />Person Filing <br />Re p o r t JUNE OKUBO <br />Tank i <br />Sise <br />Product <br />1 <br />12-000 <br />NO LEAD <br />`2 <br />12,000. <br />REGULAR <br />3' <br />'20,000 <br />DIESEL <br />3. <br />2-27-91 <br />2 <br />353 <br />4. <br />I <br />❑ I hereby certify under penalty of perjury that all inventory variations for <br />the above mentioned facility were within the allowable linits for this <br />Quarter. (No in Column 13 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 no unauthorised (leak) release. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) 1 <br />List date, tank f® and amount for all variations that exceeded the <br />allowable limits. <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 al -lovable limits was due to <br />a teak 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 />(t> Quarter I - January --, march <br />Quarter 2 - April --' June <br />Quarter 3 - July --, September <br />Quarter 4 - October --> December <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Ha'e l t ooi , P.O. Rom 2009 <br />Stockton. CA 95201 466-6761 <br />EH 23 019 10/86 <br />Date <br />Tank E <br />Amount <br />1. <br />1-29-91 <br />1 <br />306 <br />I. <br />_ 1-28-212 <br />33,E <br />3. <br />2-27-91 <br />2 <br />353 <br />4. <br />3-19-91 <br />1 <br />110 <br />S. <br />'3-11-91 <br />2 <br />180 PERMIT <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 al -lovable limits was due to <br />a teak 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 />(t> Quarter I - January --, march <br />Quarter 2 - April --' June <br />Quarter 3 - July --, September <br />Quarter 4 - October --> December <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Ha'e l t ooi , P.O. Rom 2009 <br />Stockton. CA 95201 466-6761 <br />EH 23 019 10/86 <br />