Laserfiche WebLink
INVENTORY RECONCILIAT.../ <br /> QUARTERLY SUMMARY REPORT FORM <br /> I Facility Name: ' /_Carnegie S.V.R.A. Tattle <br /> Size Product <br /> FIBERGLASS 1000 unleaded <br /> a+ Facility Address: 18600 Corral Hollow R.D FIBERGLASS __1_0U0_— <br /> TRACY CA 95376 <br /> Telephone: 415 _455-5918 <br /> �f Person Filing - <br /> Report: John C.Dunn P.M.W.II__ <br /> I hereby certify underenalt <br /> p y of perjury that all inventory <br /> variations for the above mentioned facility were �wlitt�h//inn the <br /> allowable limits for this quarter. (No iry+�/3y(y_`+, • E <br /> Inventory Reconciliation Sheet. ) ,1.[liFslV <br /> Inventory variations exceeded the allowable 110ts5fWQthis <br /> quarter. I herebycertify under penalty (� �� L' <br /> y <br /> source for the variation was not due to�ta' <br /> release. (Yes in Column 13 of the Inver;tor �on <br /> Sheet) . <br /> List date, tank 1, amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> 5 ate Tank. M Amount <br /> Reason <br /> 1. <br /> 2. <br /> 3 . <br /> 4 . <br /> 5. <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 /> he end of each quarter. Circle appropriate quarter. <br /> Quarter 1 - January---------->March <br /> Quarter (l - April ----------->June <br /> � . <br /> Quarter 3 - July ------------>September <br /> ;. Quarter 4 - October ---------->December <br /> Send to: SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 1603. E. Hazelton Ave. , P.O. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 468-3420 <br />