Laserfiche WebLink
INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name : American Savin2s Bank, f.a. Tank Size Product <br /> 1 119 X 210 Unleaded <br /> Facility Address -. 1888 Lockheed Ct. <br /> Stockton, Ca 95201-0300 <br /> Telephone: (209) 546-2415 <br /> Person Filing <br /> Report : . Robert D. Kryzsko <br /> I hereby certify under ;penalty of perjury that all inventory vari.atior. <br /> for the Above mentioned facility were within the allowable limits for <br /> xxx this quarter . ( No in Column 13 of the Inventory Reconciliation Sheet. <br /> Inventory variations exceeded the allowable limits for this quarter . <br /> ❑ hereby certify cinder penalty of perjury that the source for the varia- <br /> tion was not due to unapthorized ( leak ) release. ( Yes in Columm 13 of <br /> the Inventory Reconciliation Sheet ) . <br /> Link: date, flank # r and amount for all variations that exceeded <br /> the allowable limits . <br /> Date Tank # Amount <br /> 1 . <br /> 2 . <br /> 3 . <br /> 4 . <br /> 5 . <br /> Additional dates/amounts shall be continued on a separate sheet <br /> paper and attached . <br /> If the source of the variation which exceeded allowable limits was <br /> due to a leak , the incident shall be reported to San Joaquin Local <br /> Health District ; Environmental Health Division, within twenty-four <br /> ( 24 ) hours and an unauthorized release report submitted . <br /> The quarterly summary report shall be submitted within fifteen ( 15 ) days <br /> of the enol of each quarter . <br /> 6iiitei) - January---_------->March <br /> Quarter 2 - April------------>June <br /> Quarter 3 - July-----------w--->September <br /> Quarter a - Octobcr---------->December <br /> Send to: SAN JOAQUIN FOCAL HEALTH DISTRICT <br /> 1501 E. Hazelton, P.O. Sox 2009 <br /> Stockton, CA 95201 468-3420 <br /> C-H 23 019 10/86 <br />