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April 7 1992 <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Name D S S Company <br />Tank I Site Product <br />Facility;Address: G1 10,000 unleaded <br />639 W. Clay St. D1 10,040. diesel <br />Stockton, Ca. 95206 D2 <br />Telephone: 109-948-0302 - 6,000 diesel <br />Person Filing <br />Report Boyd Groves <br />i <br />I hereby certify under penalty of perjury that all inventory variations for <br />the above oenCioned facility were within the allowable liaits for thin <br />quarter. (No in Column D of the Inventory Reconciliation Sheet) <br />El <br />Inventory vaciatioas exceeded the allowable limits for this quarter. <br />hereby certify under penalty of perjury that the source for the variation <br />was not due to an unauthorized (leak) releiae. (Yes in Coluaan..17 vf, the ._ <br />Inventory Reconciliation Sheet) <br />List date, tank 1, and amount for all variations that exceeded the <br />Allowable limits. <br />Date Tank f Amount <br />I. <br />2. <br />4. <br />dates/jm <br />PAdttiondl attached. <br />uots shall be continued on a separate sheet of <br />paper and attached. <br />If the source of the variation which-exceeded at-lovable limits vas due to <br />At leak the incident shall be reported to S.J.L.H.D. Environmental licalcl, <br />Within 24 hours and an unauthorized release report submitted. <br />9 e quarterly summary report shall be �cubmictcd vithih 15 days of the end of cacti <br />✓(�arccr I - Januar > Harch <br />Q'aarccr 2 - April --> June <br />Quarter 3 -July <br />--> Scptcmh<:r <br />Quarter 4 - October --> December <br />Send to: SAN JOAQUIN LOCAL!. HEALTH DiSTHLCT <br />160 L 1:. 11aze I I (,ii , : 1). 0. 11ox ZOOS) <br />Siockton, CA 05201 466-67b[ <br />1,0 10/86 <br />