Laserfiche WebLink
RECEIV ) <br /> INVENTORY RECONCILIATION 6. <br /> - QUARTERLY SUMMARY REPORT FORM APR 8 1991 <br /> ENVIRONMENTAL HEALTH <br /> °P�' PERMIT/SERVICES <br /> Facility Name: <_S f�j�/}— j �} ��/y/ VT&nk # Size. <br /> Product <br /> Pacilitr�Address: CD'c.� ,745i"& A- <br /> �- �Or/iJl= ��� <br /> Telephone : <br /> Person Filing <br /> Report J <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. (Ko 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 1, and amount for all variations that exceeded the <br /> allowable lictits. <br /> Date Tank f Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional daces/amounts 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 llcalth <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 /> CQuarter I - January <br /> Quarter 2 - <br /> Quarter 3 - July --) September <br /> Quarter 4 - October --> DLcember <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Haze 1 L(>Il , P . O . Box 2009 <br /> Sc:ockton , CA X15201 466-6781 <br /> UCT 40 10/86 <br />