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TNVENTORY RECONCILIATION <br /> RTERLY SUMMARY REPORT FOR <br /> Facility Name: TEXACO FOOD MART & C/W Tank I size -Product <br /> 1 10000 Re <br /> Facility Address: 440 West Charter Way 2 10000 Super <br /> Stockton, Ca . 95206 !'r-ileaded Reg <br /> i Telephone: Texaco 916 361 2665 4 10000 viiesel 42 <br /> Person Filing <br /> Report: Div r"kt Ren Ii . 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 /> Date/ Tank Amount It -� <br /> :lLt Yl z -CI' <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 report submitted. ►. <br /> 10 <br /> The quarterly summary report shall be submitted within fifteen (15) days of <br /> the end of each quarter. Circle appropriate quarter. <br /> Quarter 1 - January---------->March <br /> Qua er -),- April ----------->June <br /> Quarter 3 - July ------------>September <br /> Quarter 4 - October -----2--->December <br /> Send to: SAN JOAQUTN PUBLIC HEALTH SERVICES <br /> ENVIRONT-ID1 '!J, HEALTH DIVTSTnN <br /> 1601 E. Hazelton Ave. , P.O. Box .2009 <br /> Stockton, CA 95201 <br /> (209) 468-3420 <br />