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INYENtORY RECONCILIATION <br /> T. <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Nene: Port Stockton Food Dist Tank I Size Product <br /> i <br /> Facility Address; 1950 E Miner 1 2000 Diesel <br /> Stockton , CA 95205 <br /> Telephone : 209-948-1814 <br /> Person Filing <br /> Report Randy Thomas <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 /> 0 Inventory variations exceeded the allowable limits for thin quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> van mot due to in unauthorised (leak) release. (Yes in Column IJ of the <br /> Inventory Reconciliation Sheet) <br /> List dater tank to and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 1. <br /> 2. <br /> 7. <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 which exceeded allowable limits was due to <br /> ■ leak the incident shall be reported to 5 . .1 . I,. H . D . Environmental Health <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end o[ each <br /> quarter. <br /> Quarter I - January --) March <br /> Q•)arter 2 - April --> Juue N <br /> Quarter ) - July --) September 01 <br /> Q-jarter 4 - October --) Ikcember 1% <br /> Send to: SAN JOAQU I N LOCAL HEA1.1.1i 1W;'I If 1(;1' <br /> 1001 E . Haz(. 114,11 • I' . 0 R"u•: )1111'1 <br /> Slockton • CA '1')201 46(. -olbl <br /> �II:'F 100 In/ Ah <br />