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Quarter No 4 October-December 1991 <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM (mont6-,rv) ol�e nctk <br /> Facility Name: Stockton Unified School Dist. Tank # Size Product <br /> Facility Address : 1932 N. E1 Pinal Dr. 12 K Diesel <br /> 944-40qtnrktnn CA Diesel <br /> Telephone: G s line <br /> Person Filing Gasoline <br /> Report: . Charles Leubner <br /> I hereby certify under penalty of perjury that all inventory variations <br /> Q for the above mentioned facility were within the allowable limits for <br /> this quarter. (No in Column 13 of the Inventory Reconciliation Sheet. ) <br /> Inventory variations exceeded the allowable limits for this quarter. I <br /> ❑ hereby certify under penalty of perjury that the source for the varia- <br /> tion was not due to unauthorized ( leak) release. (Yes in Column 13 of <br /> the Inventory Reconciliation Sheet) . <br /> List date, tank # , and amount for all variations that exceeded <br /> the allowable limits . <br /> Date Tank # Amount M�� j 19921 . 10-3-91 4 + 130 cal 10,11,VIRO'N",nE;',,PAL.. HF-A LTH <br /> 2 . 11-26-91 2 - 130 Gallons PERN1I} / LKV!LLS <br /> 3 . 11-20-91 3 + 79 Gallons <br /> 4 . 11-26-91 3 + 82 Gallons <br /> 5 . 11-27-91 3 + 90 Gallons <br /> Additional dates/amounts shall be continued on a separate sheet <br /> paper and attached. <br /> If the source of the variation which exceeded allowable limits was <br /> due to a leak, the incident shall be reported to San Joaquin Local <br /> Health District; Environmental Health Division, within twenty-four <br /> ( 24 ) hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within fifteen (15 ) days <br /> of the end of each quarter. <br /> Quarter 1 - January----------->March <br /> :Quarter 2 - April------------>June <br /> Quarter 3 - Jul >September <br /> Quarter 4 - October---------->December <br /> Send to: SAN JOAQUIN LOCAL, HEALTH DISTRICT <br /> 1601 E. Hazelton, P.O. Box 2009 <br /> Stockton, CA 95201 468-3420 <br /> Ell 23 019 10/86 <br />