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SENTORY RECONCILIATION <br /> r >?l QUARTERLY SUMMARY REPORT FORM <br /> Facility Namei American Savings Banksf� <br /> size 12ro�uct <br /> 1 119 x 210 Unleaded <br /> Facility Address-, 1688 Lockheed court <br /> Stockton Ca 9520170300 <br /> Telephone i 209) <br /> EEE <br /> Person Filing <br /> Report; Robert D. Kr zsko <br /> I hereby certify under penalty of perjury that all inventory <br /> C] variations for the above mentioned facility were within the <br /> allowable limits for this quarter . (U4 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 penury that the <br /> source for the variation was not due to authorized (leak) <br /> releaee . (Its_ n 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 /> Realpa.. <br /> 1.Juiy. 25, 1991 #1 83.0 Inaccurate Readings <br /> 2 . <br /> 3 . -- ' <br /> 4 . - <br /> 5 <br /> d <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 repo►�t shall be submitted within fifteen (15) days of <br /> the end of each quarter. Circle appropriate quarter. <br /> Quarter 1 - January---------->March <br /> Quarter - April ----------->June <br /> rter - July ------------>September <br /> uar er 4 - October --------.>December <br /> Send to; SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 1601 E, nazelton Ave , , p , O . Box 2009 <br /> Stockton, CA 95201 <br /> (209) 468•-342© <br /> EH 23 019 ( 10/89) <br />