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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: _c+ k Pn ar Tank / Sire Product <br /> 45965-3 1000 gni. Unlea e <br /> Facility Address: 1804 West Main St . qal. Regular <br /> Stockton, CA <br /> Telephone : 465-3700 <br /> Person Filing <br /> Report Walter J. Bishop <br /> © I hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> quarter. (No in Column 13,-,f the laventory Reconciliation Sheet) <br /> ElIaventocy variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to as unauthorised (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank 1, sad amount for 211 variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates"amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation whichexceeded allowable limits was due to <br /> a leak the incident shall be reported to S .J . L . H . D . Environmental Healch <br /> Within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of cacti <br /> quarter. <br /> Quarter I - January --) March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> ]eptemhcr <br /> Quarter 4 - Occober --) Decemher <br /> Send to: SAID JOAQUIN LOCAI. HEALTH DIS'IHICT <br /> 1601 is L'azc I t -o . 1' . 0 . lio m 2009 <br /> S1. Orbt_oil , CA '15201 466 -67b1 <br /> llt;'T 40 10/ 80 <br />