Laserfiche WebLink
6 - 6 <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> FaciLity Name: Tank f Sizc. Product <br /> FacilitAddress, <br /> Te lephone <br /> Person Fi.li.ng . <br /> Report <br /> I hereby certify under penalty of perjury that all inventory variations for <br /> the above sfentioned facility were within the allowable limits for this <br /> quarter. (No in Coluaax 13 of the Inventory 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 /> vis not due to an unauthorized (leak) celeise. (Yes is Column 13 of the <br /> Inventory Reconciliation Sheet) ' <br /> List date, tank f, and aa.ount for 211 variations that exceeded the <br /> allowable limits- <br /> Da te <br /> imits_Date Tank 0 Amount <br /> 3. <br /> 4- <br /> Additional dates/amounts shall be continued an a separate sheet of <br /> paper and accached. <br /> If the source of the variation which- exceeded allowable limits was due to <br /> a leak the incident shall, be reported to S .J .I„H . D. Environmental Ilea lth <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of each <br /> quarCcC. <br /> Quarter i - January --) Mare:h <br /> sactcr - pri -- e <br /> Quarter 1 - July --> Scptcmher <br /> Quartcr 4 - October --) lk-cember <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Haze 1 toil . P .O . BOX 2009 <br /> Stockton , CA 95-201 466-6781 <br /> LICT 40 10/86 <br />