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INVENTORY RECONCILIATION <br /> _UARTERLY SUMMARY REPORT FG.,_. <br /> xaci.lity Name: TEXACO FOOD MART & C/W Tank # Size Product <br /> • 1 10000 Re <br /> Facility Address: 440 '- Charter W� 2 10000I Super <br /> Stoc Ca ._ { X206 2 "nlear-'.er'. Reg <br /> Telephone: Texaco 916 X41 2665 1000(' niesel '2 <br /> Person Filing _ <br /> Report: Div P"kt Rc ? . J . Bartels <br /> I hereby certiry under penalty of perjury that all inventory <br /> variations for '--he 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 /> 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 /> The quarterly summary report shall be submitted w _ iir fifteen (15) days of <br /> the end of each quarter. Circle appropriate quarter. <br /> Quarter 1 - January---------->Marcli <br /> Quarter 2 - April ----------->June <br /> Quarter 3 - July ------------>Septe­'-_ � <br /> , r <br /> Quarter 4 - October ---------->Dec-_ <br /> -nal to: SAN JOAQUIN PUB--Tr ?'FAT TIT '77: --__ <br /> ENVIRONMENTr"- --- <br /> 1601 E. Hazelton Ave. , P.O. Box �tu� <br /> Stockton, CA 95201 <br /> (209) 468-3420 <br />