Laserfiche WebLink
v <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: �(/)Q�/� �UC/4 nk I Sice. Product <br /> L L / C aiP�p <br /> Facility Address: �s&�V 7 `�P150,1 Sf � <br /> Tf C 95zDs <br /> Telephone : Vy3-5-6oO <br /> Person Filing S / <br /> Report �ahn/ /Ines ocVp d/ � <br /> I hereby certify under penalty of perjury that all inventory variations for <br /> the above scentioned facility wcr_ within the a'llo. abic limits for this <br /> quarter. (No in Column 13of the Inventory Reconciliation Sheet) <br /> Inventory variations exceeded the allowable limits foe tbis 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 /, sad aasount for 211 variations C.1st exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 'm y <br /> I- '161 E r E ; <br /> 2. _ OCT 91onn <br /> 3. ENVIRONMENTAL HEALTH ' <br /> 4. PERMIT/SERVICES <br /> S. <br /> Additional dates/::nouats shall be contioued on a separate sheet of <br /> paper and attached. <br /> If the source of (he variation which exceeded allowable limits was duc to <br /> a leak the incident shall be reported to S .J . L . H . D . Environmental Health <br /> wzChzn 24 hours and an unauthorized release report submitted. <br /> I-hc quarterly suo:nary report shall be Rubmi(Ced within 15 days of the end of each <br /> gwarCer. <br /> Quar(cr I - January --) March <br /> QQurcer 2 - April --> Ju,.,. / <br /> . Quarter ) - July __) Seri' <br /> Q"urccr 6 - Occobcr --) 11k c, mbcr <br /> Send to: SAN JOAQUIN 1.0CA1. HEAIITli UltifklC't' <br /> 1601 E . I!�ulton , 1' .0 . Itos 2()(1 ) <br /> Stockton . CA ')i201 46h - GJbI <br /> UGI 40 l O/ r{G <br />