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W.:sT►+lk '�-``. rz'Cil _fir w <br /> ENTORY RECONCILIATION JUL 15 1991 <br /> QUAEIERLY SAY REPORT FORM ENVIRONMENTAL H `fH <br /> �.NVlRONM NT � EAL <br /> Facility Name ; American SavinEs Dank, f.a. PE Ml / VI ES <br /> 1 119 x 210 Unleaded <br /> Facility Address: 1�L Lockheed Court <br /> Stockton Ca 52077300 <br /> Telephone ., �209 54 -2 1 <br /> Person Filing <br /> Report; Robert D. Kryzsko <br /> I hereby certify under penalty of pen ury that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quarter. (LL2 in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> Inventory variations excoaded 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. (111 in Column 13 of the• Inventory Reconciliation <br /> Sheet) . <br /> List date , tank J , amount for all variations and the reason <br /> for exceeding the allowable limits . <br /> B Il)S.._ Ami $e-A=_._ <br /> 1 , A-jpril 1,1991 #1 78.0 Inaccurate Readings <br /> .�. <br /> 2 .A-aril 12, 1991 #1 81.0 Inaccurate Readings <br /> 3 . <br /> 4 . <br /> Is 5 <br /> :J . <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 Publio <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 repd' rt shall be submitted within fifteen (15) days of <br /> the and of each quarter. Circle appropriate quarter, <br /> Quarte- - January---------->March <br /> uarter 2 - April ----------->June <br /> Quarter 3 - July +----------->September <br /> Quarter 4 - October --------->December <br /> send to; SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 1601 E, Hazelton Ave , , P , O , Box 2009 <br /> Stockton, CA 95201 <br /> ( 209) 468-3420 <br /> FH 23 019 (10/39) <br />