Laserfiche WebLink
'�s A% <br /> INVENTORY RECONCILIATION \� <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Anheuser-Busch Inc. Pct <br /> Tank i Si <br /> ct <br /> 1r4cL1itY`Address: 3932 Budweiser C 1 <br /> ourt <br /> toe ton, ai ornia 95205 2. 000 al <br /> Telephone : (209) 931-5661 <br /> Person Filing <br /> Report Ron Meyer <br /> ©X I hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable Limits for this <br /> quarter. (He in Colu® 13of the Inventory Reconciliation Sheet) <br /> ElInventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> vas not due to so unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and amount for all variations chat exceeded the <br /> allowable limits_ <br /> Date Tank / Amounc <br /> 2- <br /> 3. <br /> 4. <br /> 5. <br /> Addicioaal dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If 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_ Environmental Mcalth <br /> within 24 hours and an unauthorized release report submitted. <br /> The Quarterly summary report shall be Fubmitted within 15 days of the end of each <br /> quarter- <br /> Quarter I - January --) March <br /> Qvartcr 2 - April --) Ju„e <br /> Quarter 3 - July --) September <br /> Quarter 4 - October --) December <br /> end to: SAN JOAQUIN LOCAL. HEAL7'li DISTRICT <br /> 1601 E. I!azelttm . P .O . li<ix 20()9 <br /> Stockton . CA 95201 466 -6761 <br /> '1' 40 10/86 <br />