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INVENTORY RECONCILIATION <br /> _.iRTERLY SUMMARY REPORT FORb, <br /> Facility Name: TEXACO FOOD MART & Tank Size Product <br /> 1 10000 Re <br /> Facility Address: 440 West Charter Way 2 10000 Super <br /> tockton , Ca . 95206 3 12000 T7nleaded Reg <br /> Telephone: Texaco 916 361 26.65 4 10000 Diesel 42 <br /> Person Filing <br /> Report : Di,,, A"k t Rep 11 . J . Bartels <br /> I hereby certify under penalty of perjury that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quarter. (No in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> Inventory variations exceeded the allowable limits for this <br /> quarter. I hereby certify under penalty of perjury that the <br /> source for the variation was not due to authorized (leak) <br /> release. (Yes in Column 13 of the Inventory Reconciliation <br /> Sheet) . <br /> List date, tank #, amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> DaLVe Tank Amount Reason <br /> d �f �e2L1 <br /> 1. ] ' <br /> 2 . <br /> 3 . <br /> 4 . <br /> 5. <br /> Additional dates/amounts shall be continued on a separate <br /> sheet of paper and attached. <br /> If the source of the variation which exceeded allowable limits <br /> was due to a leak, the incident shall be reported to Public <br /> _ Health Services of San Joaquin County Environmental Health <br /> Division, within twenty-four (24) hours and an unauthorized <br /> release reper-- submitted. % <br /> The quarterly summary rc�port shall be submitted within fifteen (15) days of <br /> the end of each quarter. Circle appropriate quarter. <br /> Qu-artPr �� January---------->March <br /> Quarter 2 - April ----------->June <br /> Quarter 3 - July ------------>September <br /> Quarter ":: t-ober ' -->December <br /> Send to: "' "'" ^T'BT IC HEALTH SERVICES <br /> - I DIVIS?r?T.: <br /> 1601 Ave. , P.O. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 468-3420 <br />