Laserfiche WebLink
INVENTORY RECONCILIATION �J <br /> QUARTERLY SUMMARY REPORT FORM <br /> A P ? a: ✓y <br /> Facility Name: SHAUGIINESSY CAR WASH Tank 1#N1 f( iv Sime:.. h._ 1 lla'product <br /> Facility Address: 601 F. Miner Avenue , ,1 'Reaul.ar <br /> 2 17. 000 Su er Unl. <br /> Str�ckt on CA 95202 3 12 000Rea. Un7. <br /> Telephone : ( 209) 465-2542 <br /> Person Filing <br /> Report Lila Billteirner <br /> ® I hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> quarter. (No in Column 13of 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 /> was not due to an unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank t, and amount for all variations that exceeded the . <br /> allowable limits. <br /> Date Tank f 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 licoits was due: to <br /> leak the incident shall be reported to ,J 1 H . p _ 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 cacti <br /> quarter. <br /> Quarter�I January --} Harch <br /> Q•.arter April <br /> Quarter 3 - July --) Septerubvr <br /> Quarter 4 - October --) Dc-cember <br /> Send co: SAN J0AQU1r4 LOCAL HEALTH DISTRICT <br /> 1601 1" , Haze 1 t ()n , P . O . Box 1009 <br /> SLockCon , CA 95201 /460 -G7bl <br /> l;T 40 10/86 <br />