Laserfiche WebLink
INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: ROTO ROOTER Tank # Size Product <br /> 1 10.000 UNLEADED <br /> Facility Address: 3480 E. CARPENTER RD 2 1 .000 DIESEL <br /> STOCKTON <br /> Telephone: 465-2616 <br /> Person Filing <br /> Report: TONY VALENZUELA <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. ( _o 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 1, amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> Date Tank I Amount Reason <br /> 1. 5-30-91 1 25 GAL. <br /> 2 . 6-4-91 1 45 GAL. <br /> 3 . 5-20-91 2 8 GAL, DELIVERIES <br /> 4. 5-22-91 2 10 GAL. <br /> 5. <br /> Additional dateslamounts 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) daps of <br /> the end of each quarter. Circle appropriate quarter. <br /> Quarter 2 - Januar -- -->March <br /> Quarter 2 - ril ----------->June <br /> Quarter 3 - July ------------> ep ember <br /> Quarter 4 - October --------->December <br /> Send to: SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 1601 E. Hazelton Ave. , P.O. Box 2009 <br /> Stockton, CA 95201 <br /> (299) 468-3420 <br />