Laserfiche WebLink
INVENTORY RECONCILIATION <br /> 1 1�nJ <br /> QUARTERLY SUMMARY REPORT FORM tNVIRCl�lwlIJf/�LF� ,�_ <br /> SRESFIEARS CHEVRON #33825 <br /> racility KanetPHONE.- 823.5717 r <br /> Taal I site Product <br /> Facility Adere.. FES CALUG NIA 95336 <br /> Telephone : 61 <br /> Person Filirt� R �— <br /> Report <br /> Ur�Ibereby certify under penalty of perjury that all inventory variations for <br /> the above weatioaed facility, were within the allowable limits for this <br /> quarter. (Ko is Colum 13of the lovencory Reconciliation sheet) <br /> ❑ Inventory variations exceeded the allowable limits for this quarter. T <br /> hereby certify trader penalty of perjury that the coerce for the variation <br /> was not due to as unauthorized (Leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation sheet) t <br /> List dater tank Ir and amount for all variations chat exceeded the <br /> allowable limits. <br /> Date Taok I Amount <br /> 1. <br /> 2. <br /> 4. <br /> S. <br /> Addltioaal dateaf amount: shall be continued oo a separate sheet: of <br /> paper and attached. <br /> If the source of Che variation ..hick cecrcded allow ble limits w s due to <br /> • luk the incident shall be reported In S .J . L . H . O . Environmoc neat Ilcalth <br /> within 76 hours and an unaothor,tcd release report submiCCed. <br /> 111e Quarterly au.oary report shall be ..,bmi(ted within 15 days of the end of each <br /> quarter . <br /> Quarter 1 - Janu.ry <br /> Q'u cter I - April <br /> Quarter I - July --> ie p[cm 6.•r <br /> Q,u rtr C - October --) O'rccmhcr <br /> Send to: SAN JOAQUIN LOCAL 11EALTli DISTKICI' <br /> 1601 E . l azellras , P .O Itnv lot),) <br /> Stockton . CA 75201 466-67b1 <br /> U1:7' 40 10/86 <br />