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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Carl Karcher Ent. Tank i Size Product <br /> 800 Mellon ,0 Diesel 712 <br /> Ave.. <br /> Facility Address: - 550 Diesel-72— <br /> Manteca, <br /> iesel 2Manteca, CA 9533 <br /> Telephone : 209-823-9251 <br /> Person Filing <br /> Report Terry Langstaff <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 of the Inventory Reconciliation Sheet) <br /> E] Inventory 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 an unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable limits. <br /> Dale Tank / Amount <br /> ��Pox� o <br /> 3. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which. exceeded allowable limits was due to <br /> a leak the incident shall be reported to S .J .L. H . D . EnvironmentaL Ncalth <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 each <br /> quarter_ <br /> Quarter I - January --) March . <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . Hazcicon , P .O . ISox 2009 <br /> Stockton , CA 95201 466-67bL <br /> LILT 40 10/ 86 <br />