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r <br /> &VE- NTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: American Savings Bank ^ <br /> 1 119 x 210 Unleaded <br /> Facility Address: 1888 Lockheed Court <br /> Stockton, Ca 95201-0300 <br /> Telephone: 209 983-4120 <br /> Person Filing <br /> Report: Robert D. Kryzsko <br /> I hereby certify under penalty of perjury that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quarter. (Ho 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 perjury that the <br /> source for the variation was not due to authorized (leak) <br /> release. (Yes 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 /> Date Tan Amount Reas2n <br /> 1. 10/29(90 1 132.5 Tnarriwate Rpadjngs <br /> 2 .11/06/90 1 102.3 Tnarriirate Rpadings <br /> 3 .—.11119 90 1 84.4 Inaccurate Readings <br /> 4 . 11/30/90 1 79.R Tnarriwate Raadings <br /> 5. '`12ZO3/9Q 1 9?.5 Tnacriiratp. Ra_adinns <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 in idem shal.1. 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 report shall be submitted within fifteen (15) days of <br /> the end of each quarter. Circle appropriate quarter. ; . <br /> Quarter 1 - January---------->March ,, <br /> Quarter 2 - April ----------->June ta 'O <br /> Quarter 3 - July ------------>September- .J Q ` <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 /> EH 23 019 (10/89) <br />