Laserfiche WebLink
OU ART ERL , I NV ANT 0 <br /> RY �PORTING <br /> Tank # Size Product <br /> tl ;CO I;v <br /> Name: � . <br /> Facility <br /> Address: D <br /> Facility <br /> City: <br /> County: ( (- <br /> State: Haste 011 <br /> `471 <br /> Of Per) facility <br /> 'Jury that all P� ,�a ltll� <br /> I hereby certify under penalty wei• �i <br /> ❑ level variations for the above mentioner ,gag <br /> within allowable limits for this qf or <br /> Inventory variations exceeded thunderope�altyioftperjury R L 9 <br /> quarter. I hereby certify f,EN1ALHEACTH <br /> this q p�RpNTISERVICES <br /> that the source for the variation was NOT due o L1 •:•'•R <br /> unauthorized (leak) release. <br /> List exceedtank # and the allowablenllmitnt s all variations <br /> tha <br /> Date <br /> Tank t Amount <br /> ate Tank # Amount <br /> l I �S <br /> l � � e <br /> The quarterly summary report shall be submitted withl 15 days <br /> of the end of each quarter. Submit by All 15 <br /> Quarter i — January thru March Submit by {y 15 <br /> Quarter 2 — April thru `lune Submit by sober 15 <br /> Quarter 3 — July thru September -- <br /> Quarter 4 — October thru December — Submit by bury 15 <br /> Send To (Local Agency) : <br /> KEEP COPIES OF THIS FORM FOR YOUR ( RECORDS <br /> DATE MAILED �� -------- --- _---- ------ <br />