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INVENTORY RECONCIL1AT10F <br /> •. _ ,QUARTERLY SUMMARY REPORT FOmg <br /> Facility Name: TEXACO FOOD MART & C/?a Tank Sizie Product <br /> l 10000 Re <br /> Facile ' Address: 440 West Charter Way 2 10000 Super <br /> Stoc1;tc :-_, Ca . 95206 3 12000 Unleaded Reg <br /> relepi: _Tex=cn 916 3E ! W165 10000 niesel 42 <br /> Perso: i ling <br /> Report • Div Vk t Rep J1 . J . Bartels <br /> r <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 Reaso <br /> A& Z�-41A_ <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 submitt. i . <br /> The quarterly summary report sha' be submitted within fifteen (15) days of <br /> the end of each quarter. Circle appropriate quarter. <br /> Quarter 1 - Januarl---------->March <br /> Quarter. 2 - April ------------>June <br /> Quarter 3 - July ------------>September <br /> Quarter 4 - Oct_ ' - - . -- .-->December <br /> Send to: c771 17 •T„!,;.,- a . STT'VICES <br /> 1601 E. hazeiLoi. .yvu. , r.v. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 468-3420 <br />