Laserfiche WebLink
S!. <br /> INVENTORY RECONCILIATION : <br /> QUARTERLY SUMMARY REPORT F0RM 1/ <br /> Faci Lity_ Kase: <br /> c� <br /> A-All-i'AA /YI//Y/ — Tank F ...~ Size'. •.. Pra v �- <br /> Facility Address: /� Q <br /> DP Com- lJ �L. <br /> Telephone : _ 1420 9 �S<P" <br /> Person Filing <br /> Report �10N1',f <br /> ® I hereby certify under penalty of perjury that all inventory variations for <br /> J� the above mentioned facility were within the allowable limits for this <br /> quarter. (Ko in Column 13 of the Invcatory Reconciliation Sheet) <br /> QInventory variatioas 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) release. (Yea in Column '13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, <br /> tank f, and amount for all variatioaa that CACEW <br /> allowable limits_ OCT 2 <br /> Date Tank f Amount N�IRONMENI_AL�F"�I <br /> • @�-�°tMIT/5�.�V1�� <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> A.dditioaal dates/amounts shall be continued on a tcparatc ahcet of <br /> paper •and attached. <br /> If the source of the variation vhich. cxcecded a1•lovable limits was due to <br /> A leak the incident shall be reported to S .J .L.H . D .' Environmental Health <br /> WLChin 24 hours and an unauthorized release report submitted. <br /> The quarterly summary rcpoct shall be r.ubmitccd vichin 15 days of the end of each <br /> quarter. _ _..._..._...- <br /> Quarter I - January --> March <br /> Quarter 2 - Aprtl TTun� <br /> Quarter 3 - July --> Sepcemhc:r <br /> Quarter 4 - October --> (h-ccmber <br /> Send co: SAN JOAQUIN LOCAL •HLALTH DISTRICT <br /> 1601 E. 11.3zc 1 Lc+n , P-. 0 . 1�ox 2009 <br /> SLockcon , b -95201 466-6781 <br /> LILT 40 10/ 86 <br />