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i,i. <br /> INVENTORY RECONCILIATION <br /> iRTERLY SUMMARY REPORT FOI <br /> k . Facility Name: TEXACO FOOD MART & C/WTank # ze P roduct <br /> 1 10000 Re <br /> Facility Address: 440 West Charter Way 2 10000 Super <br /> Stockton, Ca . 95206 ' illeaded Reg <br /> f. Telephone: Texaco 916 361 2665 9 10ciii Diesel 42 <br /> Person Filing <br /> Report: Div N7ct Rep H . 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 Reason <br /> 1. <br /> T <br /> 2 .- <br /> 3 <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. P. <br /> The quarterly summary report shall be submitted within fifteen (15) days of <br /> the-end of each quarter. circle appropriate quarter. <br /> r Quarter 1 - January---------->March <br /> Quarter 2 - April ----------->June <br /> Y Quarter 3 - July ------------>September <br /> uarter .October -------'--->December <br /> .yfi' W <br /> end * SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> MM `` ENVIRON? HEALTH DIVISInN <br /> 1601 E. Hazelton Ave. P.O. Box 2009 <br /> " Stockton, CA 95201 <br /> (209) 468-3420 <br /> • V V _ _ W W <br />