Laserfiche WebLink
QUARTERLY INVENTORY REPORTING <br /> ��/ZPp/27-cN�aTErc sr z� <br /> Facility Name: Tank 4 Size Product/ y1rn Su 2Bvo <br /> Facility Address: eNe�e7E!S way 8srn) r2E4uLafz <br /> City: <br /> S7•Q4r- ToN 3 BSao leu 2out7 <br /> County. .9 4-N /0,+Q UIN <br /> State: eA uF <br /> Waste 011 <br /> I hereby certify under penalty of perjury that all product <br /> level variations for the above mentioned facility were <br /> within allowable limits for this quarter. ,L j <br /> Inventory variations exceeded the allowable limits for <br /> this quarter. I hereby certify under penalty of perjury T 1 <br /> that the source for the variation was NOT due to an 7 7989 <br /> unauthorized (leak) release. ENVIRONMENTAL HEALTH <br /> List date, tank t and amount for all variations <br /> PERMIT/SERVICES <br /> that exceed the allowable limits <br /> Date Tank # AmI <br /> Date Tank t Amount <br /> A- Th-CH <br /> The quarterly summary report shall be submitted within 15 days <br /> of the end of each quarter. <br /> Quarter i – January thru March — Submit by April 15 <br /> Quarter 2 – April thru June Submit by July 15 <br /> Quarter 3 – July thru September — Submit by October 15 <br /> Quarter 4 – October thru December – Submit by Janaury 15 <br /> Send To (Local Agency) : <br /> KEEP COPIES OF THIS FORM FOR YOUR OWN RECORDS <br /> DATE MAILED /f J� –(`y <br />