Laserfiche WebLink
INVENTORY RECONCILIATION <br /> QUARTERLY SUMMITRY REPORT FORM <br /> Facility Name: J & L MARKET Tank # Size Product <br /> 1 2 , 000 Gas unieadeo <br /> Facility Address: 8115 S . E1 Dorado 2 10 , 000 as Z Keg . <br /> French Camp , Ca . 7 3 10 , 000 Gas - Unleaded <br /> Telephone: - <br /> Person filing <br /> Report: . <br /> I hereby certify under penalty of perjury that -all inventory variations <br /> for the above mentioned facility were within the allowable limits for <br /> X this 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 varia- <br /> tion was not due to unauthorized ( leak) release. (Yes in Column 13 of <br /> the Inventory Reconciliation Sheet) . <br /> List date, tank 1 , and amount for all variations that exceeded <br /> the allowable limits . <br /> D a t c <br /> Tank # Amount <br /> 2 . <br /> 3 . <br /> 4 . <br /> 5. <br /> Additional elates/amounts shall be continued on a separate sheet <br /> paper and attached. <br /> If the source of the variation which exceeded allowable limits was <br /> due to a leak, the incident shall be reported to San Joaquin Local <br /> Health District; Environmental Health Division, within twenty-four I <br /> (24 ) hours and an unauthorized release report submitted. <br /> he quarterly summary report shall be submitted within fifteen ( 15 ) days <br /> f the end of each quarter. <br /> (__2.uarter 1 January---------->March <br /> Quarter 2 - April------------>June <br /> Quarter 3 - July------------->September <br /> Quarter - October---------->December <br />:nd to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton, P.O. Box 2009 <br /> Stockton, CA 95201 468-3420 <br /> • 4 <br /> 123 019 10/86 <br />