Laserfiche WebLink
N900 j�f <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: O �Ilho &W24-2 ov Tank / Size. Product <br /> FaciLity4ddress: /4/� /- <br /> Telephone : <br /> Person F ing <br /> Report Yaz—�/ <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 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 /> was not due to an unauthorized (leak) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank i, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 3• <br /> 4. <br /> 5 //-J1- L7 <br /> Additional dates/asaouots 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 Ilea Ich <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 - January --) March D ���nJ•)�n <br /> QVa r[cr 2 - April --) Junc 14�sa• U L''VVVVVV''lll'' <br /> Quarter 3 - July --> septembcr <br /> QQ.arccr 4 - October --) I><r,•mher MAR 14 1988 <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . Hazc I t (ui • P . 0 . Rom 2009 ENVIRO PERMIT/SERHEALTH <br /> T/SER VICES <br /> Stockcon • CA 95201 466-61bl <br /> 1- 40 l0/86 <br />