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ANTORY RECONCILIATION <br /> QUARTERLY SummXRY REPORT FORM <br /> Facility Name i American Savings Bank, f.a. <br /> 1 <br /> 119 x 210 Unleaded <br /> Facility Address: 1888 Lockheed Court <br /> Stockton, Ca 95201- <br /> Telephone; <br /> 5201-Telephonei (209) 546-241 <br /> Person Filing <br /> Report: Robert D. Kryzsko <br /> xxx I hereby certify under penalty of perjury that all inventory <br /> valowabeeslimitsthe <br /> forabove <br /> thismentioned <br /> quarter. f (S2 inywere columnwithin <br /> allowable <br /> 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. (Lu in Colulgn 13 of the . Inventory Reconciliation <br /> Sheet) . <br /> List data , tank i , amount for all variations and the reason <br /> for exceeding the allowable limits . <br /> o u n <br /> Ds '1 e s n <br /> 2 . ----�--- ~---.. <br /> 3 .- � <br /> 4 . <br /> I'. <br /> 5 . ''. ENVIKUM EN� "� <br /> PERMIT/SERVICES <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 /> I <br /> release report submitted. <br /> hi fifteen 15 days of <br /> The quarterly summary repo�'t shall be submitted within ( � Y <br /> appropriate <br /> the end oP each quarter. Circle quarter. <br /> Quarter 1 - January------ >March <br /> Quarter 2 - April ----------->June <br /> Quarter - July . ----------->September <br /> uarter - 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 35201 <br /> ( 209 ) 468-3420 <br /> EH 23 019 (10/89) <br />