Laserfiche WebLink
QVY' V <br /> INVENTORY RECONCILIATION `J <br /> QUARTERLY SUMMARY REPORT FORM &Acg 6,irvc Ccl{e✓M�'ti� 's� <br /> Facility Name: Tank # Size J Product <br /> Facility Address : <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 /> 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 # , and amount for all variations that exceeded <br /> the allowable limits . <br /> Date Tank # Amount <br /> 2 . <br /> 006 <br /> 3 . <br /> 4 . <br /> 5 . <br /> Additional dates/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 <br /> ( 24 ) hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within fifteen ( 15 ) days <br /> of the end of each quarter. <br /> Quarter 1 - January---------=>March <br /> Quarter 2 - April------------>June <br /> Quarter 3 - Jul ' ` <br /> July ,.� ti�iia <br /> Quarter 4 - October---------->December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT LIAR 2 0 1991 <br /> 1601 L. Hazelton, P.O. Box 2009 ENVIR`?NMENTALHEALTII <br /> Stockton, CA 95201 468-3420 PE?MIT/SERVICES <br /> Ell 23 019 10/86 <br />