Laserfiche WebLink
INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM SEP 2 5 1992 <br /> €(dVIRC�f;JP �f�Tf=L F'� hl <br /> Facility Name: King Island Resort Tank uct <br /> Regular If lar <br /> Facility Address: 11530 W Eight Mile Rd <br /> Stockton, CA 9.521_.9 <br /> Telephone: (209) 951-2188 <br /> Person Filing <br /> Report: Wendy Hoffman <br /> I hereby certify under penalty of perjury that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quarter. (No in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> [_X( Inventory variations exceeded the allowable limits for this <br /> quarter. I hereby certify under penalty of perjury that the <br /> source for the variation was not due to authorized (leak) <br /> release. (Yes in Column 13 of the Inventory Reconciliation <br /> Sheet) . <br /> List date, tank ,f, amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> Date Tank 0 Amount Reason <br /> 1. 5/1/92-5/4/92 Regular (75.1)Average Meter Misread <br /> Temp Change <br /> 2. 5/11/92-5/18/92 Regular 80.0 Averaae Fxo rasion <br /> Temp Change <br /> 3 . 6/10/92-6/17/92 Regular 88.8 Averaae Fxnansion <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 /> the end of each quarter. Circle appropriate quarter. <br /> �er <br /> January---------->March <br /> QApril ----------->June <br /> QJuly ------------>September <br /> Quarter 4 - October --------->December <br /> Send to: SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 1601 E. Hazelton Ave. , P.O. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 468-3420 <br />