Laserfiche WebLink
INVENTORY RECONCILIATION LI `V I,p/, <br /> QUARTERLY SUZNTA0AFA11 <br /> MMARY REPORT FORM PERPhIT1$Ef&ICES <br /> Tank <br /> Size Product <br /> / ` <br /> Facility Name: 5265 <br /> 823- y�,b Lea <br /> Facility Address: <br /> an <br /> Telephone : <br /> Person Filing <br /> Report <br /> penalty of perjury that all inventory variations for <br /> I hereby certify under P were within the allowable limits for this <br /> the above mentioned facility of the Inventory Reconciliation Sheet) <br /> quarter. (No in Column <br /> variations exceeded the allowable limits for this quarter. I <br /> Inventory thase. (Y=s in Colin <br /> t the source for the variation <br /> hereby certify under penalty of perjury Y <br /> was not due to an unauthorized (leak) releal3 °f the <br /> Inventory Reconciliation Sheet) <br /> List date, tank t, and amount for all variations that exceeded the <br /> allowable limits. <br /> tank LE Amount <br /> Date Y) <br /> 1. -Io S <br /> um uu� �R tial fq5 �oAn <br /> 2. "I l� SJ er N YL� <br /> 4.3. 1n' --Ick 5 45 /aA0 <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variae to <br /> tion whichlexceeded allowableFnvironmentaimits was luHHealth <br /> S .J .L.H .D. <br /> report submitted. <br /> a leak the incident shall be repotted to <br /> within 24 hours and an unauthorized release of the end of each <br /> The quarterly summary report shall be submitted within 15 days <br /> quarter. <br /> January --� March <br /> Quarter I - __� June <br /> Qiarter 2 - April <br /> July --> September <br /> 4 <br /> Quarter - <br /> Quarter 4 - October __> December <br /> SAN JOAQUIN LOCAL HEALTH DIS'1'VtIC'P <br /> Send to: 13ox )O09 <br /> 1601 E . i'.azellon ' P .0 ' 466-6751 <br /> Stockton , CA `15201 <br /> UG'l' 40 1O/ 86 <br />