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r <br /> INVLINTORY RECONCILIATION <br /> QUARTMLY SUMMARY REPORT FORM <br /> Facility Name ; American Savings Bank, f.a. Wank Size Product <br /> 1 11 x ea a ens. <br /> Facility Address ; 1888 Lockheed* Court <br /> �tgk, on, CA 95RQ6 <br /> Telephone : " <br /> Person riling <br /> Report : . <br /> I horcby certify under penalty of perjury that all inventory vari.atioi <br /> for the above mentioned Facility were within the allowable limits for <br /> this quartar . ( No in Column 13 of the Inventory Reconciliation Sheet , <br /> Inventory variations exceodod the allowable limits for this quarter . <br /> hereby certify under penalty of perjury that the source for the varia- <br /> tion was not due to unauthorized ( leak ) release , ( Yes in Column 13 of <br /> the Inventory Reconciliation Sheet ) . <br /> List: date , tank 4 , and amount for all variations that exceeded <br /> the allowable limits . <br /> Date Tink # Amount <br /> 1 , QV1 190 1 97.5 <br /> 2 . <br /> 3 . <br /> 4 . <br /> 5 . <br /> Additional datc5/amounts shall be continued on a separate sheot <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 releaso report. submitted , <br /> The quarterly summary report: shall bQ subfnitted within fifteen ( 15 ) days <br /> of tho end of each quarter . <br /> Quarter 1 - January----------->March <br /> Quarter 2 - April------------>June <br /> Quarter 3 - July---- -----•--->September <br /> Quarter A - October---------->Decembex REutiftv <br /> q <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT JUL 0 3 1990 <br /> 1601 Z. Hazelton, P.O. Box 2009 �_NVIRQNMENTAL HEALTH <br /> Stockton , CA 95201 468-3420 PERMIT/SERVICES <br /> 4H 23 019 10/86 <br />