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R <br />INVENTORY• <br />QUARTERLY M'. REPORT * i <br />Facility Name: Pacific Bell <br />Facility Address: 124 W. Elm Street <br />Lodi. CA <br />Telephone: 12091442-2222 <br />Person Filin <br />Report: Fleet Su vr. <br />x 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 />I Tank # I Size I Product I <br />I 1 1 4.000 I Diesel <br />l I I ( <br />I <br />I I C <br />I 1 I I <br />List date, tank #, amount for all variations and the reason <br />for exceeding the allowable limits. <br />Date <br />1. <br />2. <br />3. <br />4. <br />5. <br />Tank <br />Amount Reason <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 within fifteen (15) days of <br />the end of each quarter. Circle appropriate quarter. <br />Quarter 1 - uar--------->March <br />Quarter 2 - ----------->Ju <br />a - July ------------ ember <br />Quarter 4 - October --------- >December <br />Send to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />1601 E. Hazelton Ave., P.O. Box 2009 <br />Stockton, CA 95201 <br />(209) 468-3420 <br />EH 23 019 (10/89) <br />