Laserfiche WebLink
INVENTORY RECONCILIATION <br /> `` QUARTERLY SUMMARY REPORT FORK <br /> Facility Na.,: rank i <br /> Size. :.product <br /> Facility Address: /k�� <br /> Sir�!'CrLzV <br /> Telephone : y�3- ylL� <br /> Person Fi ng <br /> Report �2�L'L/L <br /> EJI hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limit. for this <br /> quarter. (No in Column 13 of the laventory Reconciliation Sheet) <br /> ElInventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> vas not due to an unauthorized (leak) release. (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 / Amount <br /> 1. <br /> 2- <br /> 3. <br /> 4, <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and_ attached. <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 •L. H . D. Environmental Health <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 /> quarter. <br /> Quarter I - Jaauary --) March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --) Occember <br /> Send to: SAN JOAQUIN LOCAL HEAL7'li DISTRICT <br /> 1601 E . I',azclt(u) . P .O . Ros 2009 <br /> Stockton . CA 95201 466 -6761 <br /> LILT 40 10/86 <br /> i <br />