Laserfiche WebLink
INVENTORY. RECONCILIATION , <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Kinn T.siand Racnrt Tank I Size Product <br /> Facility Address: 11530 W . Eiaht Mile Rd. <br /> Stockton. CA 95219 <br /> Telephone: ( o ) 951-2188 <br /> Person Filing <br /> Report: VVnnna Malwa <br /> _I 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. (V2 in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> C-YI 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. (X, in Column 13 of t o Inventory Reconciliation <br /> Sheet) . <br /> List date, tank 0, amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> Date Tank Amount Reason <br /> 1. t �(R_t� 'Li diol ��3ar <br /> -69 . 84 Contraction due <br /> xpanQ" ski nor ue to <br /> 2. 12/26- 12 /31 /91 Regular +95 . 09 tOMDe.rp�u. e <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 /> the end of each quarter. Circle appropriate quarter. <br /> Quarter 1 - January---------->March <br /> Quarter 2 - April ----------->June <br /> Quarter - July ------------>September <br /> Vu <br /> Quarte _i_.; <br /> OCtokzer <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 />