Laserfiche WebLink
INVENTORY RECONCILIATIO ' <br /> QUARTERLY SUMMARY REPORT FORM ENVINtyOCTA O 991 T <br /> NENTALHEA, . N <br /> Facility NamezLM� T Tank* S duct <br /> Fnclllty Address: 161 L, <br /> Telepte: �j i 3) i '3 ? 3 Z <br /> rn <br /> Person Filing ;- <br /> Report: <br /> L hereby certify under penalty of perjury that all inventory variations for <br /> the above neatiosed facility were within the allowable limits for this <br /> 4tu4rtar. (H_ is Colum 13of the loveatocy Reconciliation Sheet) <br /> Inventory variatibas exceeded the allowable limits for this quarter. ' I , <br /> bereby certify under penalty of perjury that the source for the variation <br /> vas Not due CO as unauthorized (leak) releise. (Yes in Colina 13 of the <br /> Iaveatory Recoacilistion Sheet) <br /> List dates task /s and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank * Amount <br /> 1 . <br /> 1 4 _2 / t23Z� - Lzz- <br /> �\ 1--5. <br /> 7._auZ-moil r /".•')s S I Z�Si <br /> 8. /- -3 C' r? <br /> 9. <br /> �. 10. z/_{ f / 7_6 '7 <br /> V LL 12.13 15 7 <br /> 5- <br /> 14. J3 c o <br /> 15. L S-? <br /> 16. —� <br /> 17. <br /> 18. U-5' i /Gi f / '3 O <br /> Q 21. 7- <br /> 22. <br /> 23. <br /> 24. <br /> 25. <br /> 26. <br /> 27. <br /> 28. <br /> 29. <br /> 30. <br /> 31. <br /> -—71al-tieea! dates/amounts shall be eoatioued oe a separate sheet of <br /> paper and attached. <br /> Lf the source of the variation which.exceeded allowable limits was due to <br /> a leak the incident shall be reported to S.J .L.H.D. eavironmental Ucalth <br /> within 24 hours and an unauthorised release report submitted. <br /> The quarterly summary report shall be submitted within IS days of the and of each <br /> quarter. <br /> Quarter I - January --) March <br /> Quarter 2 - April --> Juno <br /> Quarter I - July --> September <br /> Quarter 4 - October --> December <br /> fend tot SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Ilazelcon, P .O. BOX 2009 <br /> Stockton, CA 95201 466-6761 <br /> . 40 10/86 <br />