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INVENTORY RECONCILIAT1016 <br /> QUARTMtLY SUMMARY REPORT FORM <br /> Facility Name ; American SaviE&s Bank . f.a. Tank 4 Size Product <br /> 1 119 x 210 Unleaded <br /> Facility Address : 1888 Lockheed Court <br /> tockton, CA 9520 <br /> Telephona , (209) 983-4099 <br /> Person Filing <br /> Report i . Vicki Antonio <br /> I hereby certi. Cy unclear penalty of penury that all inventory varkatioi <br /> for the above mentioned facility were within the allowable limits for <br /> this quarter . ( No in Column 13 of the inventory Reconciliation Sheet . <br /> Inventory variaLi.ons exceeded the allowable limits for this quarter . <br /> hereby certify under penalty of perjury that the source for the varia- <br /> tion was not clue to unap thorized ( leak ) release. (Yes, in Column 13 of <br /> the Inventory Reconciliation Sheet ) , <br /> List date , tank # , and amount for all variations that exceeded <br /> the allowable limits . <br /> Date Tank # Amount <br /> 1 . 01/29/90 1 81.0 <br /> 2 , 03/15/90 1 83.4 <br /> 3 . <br /> 4 . <br /> 5 . <br /> AdOitional datos/amounts shall be continued on a separate sheet <br /> paper and attached , <br /> If the source oC the variation which excccded allowable limits was <br /> due to a leak , the incident shall be roported to San Joaquin Local <br /> health District ; Lnvironmental 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 encs . a-f each quarter . <br /> R S <br /> Quarter 1 - January <br /> ;. <br /> -�`�Quartex 2 April-- -----w--->June , <br /> ��'..- <br /> - --�-------->Se---- tember <br /> \G eo Quart er 3 Julyp <br /> Quartcr 4 - octobcr------ --->December <br /> q: SAN JOAQUIN LOCAL HHALTH DISTRICT <br /> 1601 Z. Hazelton, P.O. Box 2009 <br /> Stockton, CA 95201 468-3420 <br /> 4H 23 019 10/66 <br />