COMPLIANCE INFO_1986-1996 - Laserfiche WebLink

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n . INVENTORY 1; JUARTERLY SUMMARY REPORT OR Facility Address. LC.% Telephone: Person Filing Revort/ r v I hereby cyrtify under penalty of perjury that all. -inventory variations for the above mentioned facility were within the allowable limits for this quarter. (No in Column 13 of the Inventory Reconciliation Sheet) Inventory variations exceeded the allowable limits for tbia quarter. I hereby certify under penalty of perjury that the source for the variation vas not due to an unauthorized (leak) release. (yes in C014= 13 of the Inventory Reconciliation Sheet) List date' tank f. and amount for all variatigas that exceeded the allowable limits. Date Tank # Amount 1 - 2. 3. 4. 5. Additional dates/amounts shall be continued on a separate sheet of paper and attached. If the aource'of the variation which exceeded 4140wabie limits was due to a leak the incident shall be reported to S . J .I.. H . D . Rnviru'-Mcntal health Within 24 hours and an unauthorized release report submitted. The quarterly summary report shall be submitted within 15 days of the end of each quarter. Quarter I - January --> March Quarter 2 - April --' June Quarter 3 - Jul --> September Quarter 4 - October --> December Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hazelton, P.O. Box 2009 Stockton, CA 95201 466-6781 UGT 40 10/86 MEN=, MIA•� E=all I I hereby cyrtify under penalty of perjury that all. -inventory variations for the above mentioned facility were within the allowable limits for this quarter. (No in Column 13 of the Inventory Reconciliation Sheet) Inventory variations exceeded the allowable limits for tbia quarter. I hereby certify under penalty of perjury that the source for the variation vas not due to an unauthorized (leak) release. (yes in C014= 13 of the Inventory Reconciliation Sheet) List date' tank f. and amount for all variatigas that exceeded the allowable limits. Date Tank # Amount 1 - 2. 3. 4. 5. Additional dates/amounts shall be continued on a separate sheet of paper and attached. If the aource'of the variation which exceeded 4140wabie limits was due to a leak the incident shall be reported to S . J .I.. H . D . Rnviru'-Mcntal health Within 24 hours and an unauthorized release report submitted. The quarterly summary report shall be submitted within 15 days of the end of each quarter. Quarter I - January --> March Quarter 2 - April --' June Quarter 3 - Jul --> September Quarter 4 - October --> December Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hazelton, P.O. Box 2009 Stockton, CA 95201 466-6781 UGT 40 10/86