Laserfiche WebLink
INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Jackpot Tank R Size Product <br /> Facilit Address: u r <br /> ,Y' 4O1 S'. Cfiernkaa Tana 4' 1 n prem U L <br /> Lodi- CA 95240 412 10,000 U L Re ular <br /> Telephone : (,)no) 369-SF54 <br /> Person Filing <br /> Report Joe Sanzo <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 Colu® 13of 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 variation <br /> was not due to an unauthorized (leak) release. kX3tXXiRX9gbMAX%JfXR1XA <br /> R7C4RF1<1X$XJ�{X7474RXAxRFXRRX$ 1t (Based on daily measurement error only.) <br /> List date. tank 1, and amount for all variations that exceeded the <br /> allowable limits_ <br /> Date Sank Amount <br /> 1. SEE ATTACHED INVENTORY CONRTOL SHEET <br /> 2- AST RTSKq DENOTE VARTATTnvc pvC=r NG ALLOWABLE LIMITS. <br /> 3. <br /> 4- <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation vhich. etceeded allowable limits was due to <br /> a leak the incident shall be reported to S .J .L.H . D. Environmental Veatch <br /> Within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted vithin 15 days of the end of each <br /> quarter. <br /> Quarter I - January --) March <br /> Quarter 2 - April --) June <br /> Quarter J - July --) Septemher <br /> Quarter 6 - October --> L?ccember <br /> "od tO SAN JOAQUIN LOCAL. HEALTH UISTHLCT <br /> 160L E . HaZeILUII , P .O . Box 2009 <br /> UCT 40 10/86 Stockton . CA 95201 466 -6781 <br />