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3rd Qtr. - 1992 <br /> K3't'E C E I V <br /> r <br /> INVENTORY RECONCIL ATION OCT 0 5 1992 <br /> QUARTERLY SUMMARY REPORT FORM <br /> _ ENVIRONMENTAL FIEAl.1'H <br /> PERMIT/SERVICES <br /> Facility Name: California Highway Patrol Tank Size <br /> � Product <br /> Ftcilit Address: 1 asoline <br /> • •r` 3330 N. Ad Art Road <br /> Stockton, CA 95205 <br /> Telephone : (209) 948-72 5 <br /> Person Fili --- <br /> Report <br /> X❑ 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. (No in Column 13 of the Inventory Reconciliation Sheet) <br /> i <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 /> was not due to an unauthorized (leak) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) _ <br /> List date, tank i, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <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 /> a 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 IS days of the end of each <br />;.� quarter. <br /> Quarter I - January --) March <br />'-j <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> Septemhcr <br /> Quarter 4 - October --> December <br /> Send to: <br /> rr SAN JOAQU IN LOCAL HEAL1'1i UI5'fK ICI' <br /> 1601 f;" Haze 1 t o n , P .O . 11OX 2009 <br /> Stockton , CA 95201 466-6761 <br /> UCT 40 10/86 <br />