Laserfiche WebLink
0 <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> 7 <br /> FaciLity. rr=me: ` 2 , -- a <br /> V- + rank <br /> =c; Product- <br /> F4Citity;Address <br /> ter- <br /> 1-3 <br /> Telephone : '3_� t,tF�E <br /> Person Filing <br /> Report <br /> I hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the-allowable '1'i=its for this <br /> quarter. (No in Column 13 of the Inventory Reconciliation Sheet) <br /> QInventory variations exceeded the allowable. limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> 'was not due to an unauthorized (leak) release. (Yes in Colu=n13 of the <br /> Inventory Reconciliation Sheet)' <br /> List date, tank /, and amount for all variations Chit exceeded the <br /> allowable limits. <br /> Date Tank Amount . <br /> z. <br /> 4. <br /> 5. <br /> Additional ,dates/amounts shall be continued on a separate sheet of <br /> Paper and attached. <br /> If the source .of Chc variation vhich. exceeded allowable limits was due to <br /> A leak the incident shall. be reported to S .J .L.H . D. EnvironmentaL llcalth <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly suammary rcport shall be Fubmittcd within 15 days of the end of each <br /> quarter. <br /> QLartcr l - January -> Harch <br /> Q'1artcr 2 - April --> Junc <br /> arter 7 July --> Scptemht.r <br /> Quarter - October --) [k�ceas6cr <br /> Send to: SAN JOAQUIN LOCAL 1{EALTH DISTRICT <br /> 160L I: . Ha•r.r 1 l(►i1 , 1' .0 . Ilnx 2()Or) <br /> Stockton , CA 95201 466-6781 <br /> T 110 10/86 <br />