Laserfiche WebLink
INVENTORY RECONCILIATION <br />TUARTERLY <br />SUMMARY REPORT <br />r..a r r <br />r <br />ENVIRONMENTAL10 RECEIVED <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. (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 variation <br />was not due to an unauthorized (leak) release. (Yes in CoLumn 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank t, and amount for all variations chat exceeded the <br />allowable limits. <br />Date Tank Amount <br />1. <br />2. <br />3. <br />4. <br />5. <br />Additional dates/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 . EavironmentaL Health <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 />Quarter I - January --) March <br />Quarter 2 - April --> June <br />Quarter 1 - July --> September <br />Quarter 4 - October --> Ikcember <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Hazelton. I' .0 . Box 2009 <br />Stockton, CA 95201 466-6781 <br />JGT 40 10/86 <br />