Laserfiche WebLink
INVENTORY RECONCILIATION 1f' 1988 <br />OCT 1- <br />QUARTERLY SUMMARY REPORT FORM <br />Facility <br />Name: <br />[acility <br />Address: <br />Telephone: <br />Person Ftlin <br />Reporc <br />0�M=-W--MM <br />I hereby certify under peoalcy of perjury that all inventory variations for <br />the above mentioned facility were within the allowable limits for this <br />quarCer. (No in Column 13of the lnvcacory Reconciliation Sheet) <br />QInventory variations exceeded the allovable limits for this quarter- I <br />hereby certify under penalty of perjury Chat the source for the variscioa <br />-as not due Co an unauthorized (leak) release. (Yes in Cal uam t3 of the <br />IavcuCory Reconciliation Sheec) <br />List date'iExak 1, and amount for all variations Chat exceeded the <br />allowable limits. <br />tzuT- <br />-Date Vit. Task 0 Amouae <br />t. <br />2. <br />3. <br />4, <br />S. <br />AddiCioaal daceslamouacs chap be contioucd on a separate sheet of <br />papccand aCtachcd. <br />if Che source of Chc vnriacioa .hich exceeded :al-luwabie limits waf due to <br />a leak the incident shall be reported to S.i.L.N.D. Envird Amenr al health <br />within 24 hours and an unau Chorixed release report submi Cced. <br />The quarterly sumary report shall be submitCed ichin IS days of the end of c.ich <br />quartrr. <br />Quarc.•r I - January --) March <br />Quart.•r 7 - J..ly --) icpccmher <br />Q..arccr 4 - occobcr D crmhcr <br />Send co: SAN JOAQUIN 1,0CA1• IIEA1.-I'li UIS'I'HIC-1 <br />1001 I;. 1:1Zt Il.ui, P.O. R,)r 1009 <br />Stockton. CA 95101 466-6781 <br />'.0 INHO <br />