Laserfiche WebLink
Er <br /> 'P,ERHEARS CHEVRON #33825 <br /> rHONL= 823-5717 INVENTORY RECONCILIATION <br /> g2n E, S'L YOSt!�WFE AVENUE <br /> , irCA CALIFORNIA 95336 QUARTERLY SUMMARY REPORT FORM <br /> Facility Naaei Tsnt / Sine <br /> Product <br /> Facility Addr . <br /> MSVSA�19—BF i E81� i <br /> Telephone : a9d haat v(;;F,JITE AVENUE <br /> Person F L,lAbl'I'E( A CALIFORNIA 953-V <br /> Repor ������Z2 <br /> 0/1 hereby certify ander pcmalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable Limits for this <br /> quarter. (Ho i■ Colum IJ of the lovcatory Reconciliation Sheet) <br /> ❑ Inventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify ander penalty of perjury that the coerce for the variation <br /> was not due to an uaauthoriaed (leak) rel else. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) t <br /> List date, tank /, and amount for all variations that exceeded the <br /> allowable linin. <br /> Date Saok / AmouoC <br /> 1. <br /> 2. 0 R W <br /> ED <br /> 3. JAN 0 6 1992 <br /> 4. ENVIRONMENTAL HEALTH <br /> s. PERWT/SERVICES <br /> Additional dates/aewuots shall be continued on a sepzrate sheet of ' <br /> paper and act x hed. <br /> if the Source of the variation ..Eich rececded allowable Limits vas due to <br /> lcsk the inctdcnt shall be reported to S .J . 1. H . D . Environmontal llcalch <br /> wiChin 2(. hours and an unauthonard rrlcasc report submitted . <br /> ITC Quarterly s...ry report shall be aubmitted within IS days of the end of each <br /> Qvartrr . <br /> Quarter I - January --> M.vch <br /> Qvartcr 2 - April --> J.'w <br /> Quarter I - July --> icptc.her <br /> Q..ar[r - October --> Ik crmhcr <br /> Send to: SAN JOAQUIN 1.0CA L HEALTH DISTRICT <br /> 1601 1: . 1(azv I I rU1 , V .0 . Ilos %0(19 <br /> Stockton , (:A 95201 466-67bl <br /> Ut:1h0 10/ H6 <br />