Laserfiche WebLink
i <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM,,\,R0rjIERVA <br />Facility dame; , CrJ�i7n1 'tank / Size <br />Product <br />Facility Address; 3p / L% A/ /4 <br />11) 140 <br />Telephone:_3Z9' y jG� Src��/Z i0 sac=0 N a <br />Person Filing r�>/ o o c -V C4e� As. t4 <br />Reportk <br />—fl.✓� (9 /J�� As7/+�n4�� 06,a --Ti <br />I hereby certify under penalty of perjury that all inventory variations for <br />��� the above mentioned facility were within the allowable limits for this <br />quarter. (No in column 13 of the Inventory Reconciliation Shert) <br />E] Inventory variations exceeded the allowable limits for this quarter. t <br />hereby certify under penalty of perjury that the source for the variation <br />vas not due to an unauthorized (leak) release. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank 1, and amount for 211 variations that exceeded the <br />allowable limits. <br />Date Tank f Amount <br />1. <br />2. <br />3. <br />4. <br />5. <br />Additional date:,/amounts shall be continued on a separate sheet of <br />paper and attached. <br />If the source of the variation which exceeded allowable limits was due to <br />A leak the incident shall be reported to S.J.L.H.D. Environmental Ilea Ith <br />within 24 hours and an unauthorized release report submitted. <br />The Quarterly summary report shall be submitted within 15 days of the end of each <br />Quartcr. <br />Quarter I - Jainuary --) Harch <br />Quarter 2 - April --> Jurat• <br />Quarter 3 - July --) September <br />Quar er 4 �- October --) Ikcember <br />Send to: SAN JOAQUIN LOCAL HEAL -1'1i DISTRICT <br />160 l E. Haze I i rrn , l' . 0. m)x 2009 <br />140 10/86 Stockton, CA 95201 466-6781 <br />