Laserfiche WebLink
INYENYORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Port Stockton Food Dist Tank / Site Product <br /> Facility Address: 2001 E. Fremont 2000 Diesel <br /> Stockton, CA 95202 <br /> Telephone : 209-948-1814 <br /> Person Filing <br /> Report Randy 'Phomas <br /> QI 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 Co luso I7of the Inventory Reconciliation Sheet) <br /> Inventory variations exceeded the allowable limits for this quarter. T <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 IJ of the <br /> Inventory Reconciliation Sheet) <br /> List date. tank Ir and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> I. <br /> 2. <br /> ]. <br /> 4. <br /> S. <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 allowable limits was due to <br /> • leak the incident shall be reported to S -J . 1. . H . D . Envirom <br /> nental 1lcalth <br /> within 24 hours and an unauthorized release report submitted. <br /> The Quarterly suaana ry report shall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter I - January --) March <br /> tarter of <br /> Q' 1 - April --> Jw�e <br /> Quarter 1 - July __) icptcmher N <br /> Q-rarter 4 - October --) December 1% <br /> Send to: SAN .JOAQ01N LOCAL IIEA1.1.1i UI !i'Iltl (;'I' <br /> 1 601 l: . l!aZe I 1 nn • I' I) It i : 711x1'1 <br /> Stockton • CA '0201 /.l,r, trlbl <br /> 111:1' 40 111/ Nh <br />