Laserfiche WebLink
INVENTORY RECONCILIATION OCT 987 <br /> QUARTERL 'SUMMARY F.PORT FORM <br /> rl -e, >' ENVIROMENTAL HEALTH <br /> FERMIT/' SERVICES <br /> Facility Name: `;- i - 2`, 1 '.6141 e�j _SMC_ Tank i Sine Product <br /> Fa cit lity-Addresa: <br /> P- 1:5-, 3� <br /> Telephone : - -} <br /> Person, Filing' <br /> Report ji A. S 1 <br /> �J I hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facilit)r were within the allowable limits for this <br /> quarter. (No in Colum 13of the loventory Reconciliation Sheet) <br /> Inventory 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 as unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank tv and amount for all variations that exceeded the <br /> allowable limits_ <br /> Date 'Tank I A=unt . <br /> 1. <br /> z. <br /> 3. <br /> 4. <br /> 5. <br /> Additional date-3/amounts shall be continued on a separate ■beet of <br /> paper and actacthed. <br /> If the source of the vzriation -hich- cxcecded al-lovable limits was due to <br /> a Leak the incident sha11. be reported to S .J .L.H . D . Environmental health <br /> within 24 hours and an unauthorized release report submitted. <br /> me quarterly summary report shall be submitted vithin 15 days of the end of each <br /> quarter. <br /> Quarter I - January --> March <br /> Qlarter 2 - April --> June <br /> Quarter 3 - July --> Septcmh(!r <br /> Q%'Arter 4 - October -> i}cccmber <br /> Send co: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 160L F . H.37.c I L(111 , P . O . li()x Zl)()g <br /> r,() lid/ fit Seockton . CA 95201 466 -6781 <br /> 10 <br />