Laserfiche WebLink
., i0 <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM HAY 1 ' 1989 <br /> Facility Name: gory Tank i size Product <br /> /O'aoz7 G�-Lf-f/JFp <br /> Facility Address: 3�� c�¢f[f�f srflZ �� Z &Zv <br /> _ _ .. -_. <br /> Telephone ; /f��ZC✓6 <br /> Person Filing <br /> Report <br /> 1 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 Sheet) <br /> YInventory variations exceeded the allowable limits for this Quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank 11, and amount for all variations that exceeded the <br /> allowable limits. «9 <br /> Date Tank I Amount <br /> 1. 1-Z- 33 z - 3 - z <br /> 2. 7- /O 3-61 z 76y.,cJ <br /> 7- 7i5' 3-06T� r� Z p4 9orf. <br /> 3. 7 flfe3 7_7 i�"tz o1e.0s,?y <br /> 4. 7- <br /> 3- ?e/ / . �f 5wj <br /> Additional dates/amounts shall be continued on a separate sheet of _ <br /> paper and attached. <br /> It the source of the variation whichexceeded allowable limits as due to <br /> a leak the incident shall be reported to S .J L . H . D . Environmental Health <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 /> Quarter_ <br /> Quarter I - January --) Harch <br /> Quarter 2 - April --> Jule <br /> Quarter 3 - July --> Septcmhcr <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEALTH OIS'IKICI <br /> 1601 L . Ilazc 11 () i , P . 0 . Rix 2009 <br /> Stockton , CA 95201 460 - 67bl <br /> UcCT 40 10/ 86 <br /> E <br />