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ENTORY 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 /> Telephone: (209) 983-4120 <br /> Person Filing <br /> Report: Vicki Antonio <br /> I hereby certify under penalty of perjury that all inventory <br /> I� variations for the above mentioned facility were within the <br /> allowable limits for this quarter. (hLg in column 13 of the <br /> Inventory Reconciliation sheet. ) ' { <br /> OCT 2 1 <br /> Inventory variations exceeded the allowable limits f9:F,, this iTF1L �i.A.Ti <br /> quarter. I hereby certify under penalty of perjury that the . . <br /> source for the variation was not due to authorized (leak) jERVICES <br /> release. (Yes in 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 /> Date Wank An 4jirite <br /> ]Readings inaccurate <br /> 1. 07/18/90 1 151.5 due to my absence. <br /> 2 . 08/30/90 1 76.o <br /> 09/21/90 1 83.0 <br /> 3 . <br /> a . <br /> 09/25/90 1 87.1 <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 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 <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 /> EH 23 019 (10/89) <br />