Laserfiche WebLink
INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> FaciLity. Name: Xti u a C c W r 'C Tank rk Site. <br /> Product <br /> • �J ��t) P, <br /> Ficility,Addres=: vim-C <br /> C' <br /> x <br /> Telephone : _- <br /> Person Filing <br /> Report cCx Sc) Irk <br /> 0----X hertby Certify under penalty of perjury that all inventory variations for <br /> the above w,entioned facility were within the allovable"'liimits for thin <br /> quarter. (No in Column 13 of the Inventory Reconciliation Sheet) <br /> ElInventory variations exceeded the aliovable. limits for this quarter. X <br /> hereby certify under penalty of perjury that the source for the variation <br /> was sot due to an unauthorized (leak) releaae. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank 1, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank ERK <br /> AmaunC . <br /> 1. .rte. ,.� <br /> Z. <br /> 3. J U L 0 6 1990 <br /> 4. _ ENVIRONMENTAL HEALTH <br /> 5. P'EIRMIT/SERVICES <br /> AddLtions1 .datcs/amouotx shall be continued on a separate sheet of <br /> piper and attached. <br /> If the aourcc .of the variation which. exc.ecdcd allowable limits was due to <br /> leak the incident shall. be reported r- S ,,) ,L.11 . D. Environmental llcalch <br /> 'within Z4 hours and an unauthorized release report submitted. <br /> The quarterly summary retort shall be aubmittcd within 15 days of the end of each <br /> quarter. <br /> Quarter I - January --> March <br /> 2111 <br /> tcr 1 - April - .) Julie <br /> ter 3 -• July --} Scptcmh<-r <br /> ( �Jarccr 4 - October -> Ckcrmbcr <br /> Send co: SAN JOAQUIN LOCAL IJEALI'li DISTRICT <br /> 1601 E . H.1zoltc,it , p .O , flax J()()c) <br /> Scoc'kton , CA 95201 466-67151 <br /> T 40 10/ 86 <br /> _ I <br />