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Ar <br /> VED <br /> \r VENTORY. RECONCILIATIO EI , <br /> QURTERLY SUMMARY REPORT FORM <br /> JAN 17 1992 <br /> Facility Name: City of Stockton Tank HEALP' oduct <br /> no lead <br /> Facility Address: 1465 S . Lincoln St . 000 no lead <br /> Telephone: 944-8305 Gkton ' CA <br /> 9S2Q6 3 12 ,000 diesel <br /> Person Filing <br /> Report: Mike Thornton/Whse . Supervisor <br /> I hereby certify under penalty of perjury that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quarter. (No in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> Inventory variations exceeded the allowable limits for this <br /> quarter. I hereby certify under penalty of perjury that the <br /> source for the variation was not due to authorized (leak) <br /> release. (Yes in Column 13 of the Inventory Reconciliation <br /> Sheet) . <br /> List date, tank #, amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> Date Tank Amount Reason <br /> 1. 10-1-91 1 271 , 1 Delivery <br /> 2 . 11 - 14-91 1 123 .6 Delivery <br /> 3 . 12-9-91 1 151 . 5 Delivery <br /> 4 . 12-16-91 1 134 Diff . Person <br /> 5 . 12- 23-91 1 181 Diff. Person <br /> Additional dates/amounts shall be continued on a separate <br /> sheet of paper and attached. , <br /> If the source of the variation which exceeded allowable limits <br /> was due to a leak, the incident shall be reported to Public <br /> Health Services of San Joaquin County Environmental Health <br /> Division, within twenty-four (24) hours and an unauthorized <br /> release report submitted. <br /> The quarterly summary report shall be submitted within fifteen (15) days of <br /> the end of each quarter. Circle appropriate quarter. <br /> Quarter 1 - January---------->March <br /> Quarter 2 - April ----------->June <br /> - Jul ------------>Se tem <br /> Quarter 4 - October --------->December <br /> Send to: SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 1601 E. Hazelton Ave. , P.O. Box 2009 <br /> Stockton, CA 95201 <br /> (2 09) 468-3420 <br />