COMPLIANCE INFO_1986-1996 - Laserfiche WebLink

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C1 INVENTORY RECONCILIATION QUARTERLY SUMMARY REPORT FOR Facility Name: Facility Address: Z3 l0 1V P A, —.® o L ; � `i 52.!1 Telephone: Person Filing Report Q- *J 1 'k M Ci F ffi R P . My I hereby certify under penalty of perjury that all inventory variations for the above mentioned facility were within the allowable limits for this q.sarter. (No in Column 13 of the Inventory Reconciliation Sheet) QInventory variations exceeded the allowable limits for this quarter. I hereby certify under penalty of perjury that the source for the variation was not due to an unauthorized (leak) release. (Yes in Column 13 of the Inventory Reconciliation Sheet) List date, tank #, and amount for all variations that exceeded the allowable limits. Date Tank # Amount 2. 3. 4. 5. Additional dates/amoubts shall be continued on a separate sheet of paper and attached. If the source of the variation which exceeded allowable limits was due to a leak the incident shall be reported to S,J,L.H.D. Environmental Health within 24 hours and an unauthorized release report submitted. The quarterly su— ry report shall be Submitted within 15 days of the end of each quarter. Quarter I - January --) March Quarter 2 - April --> June Quarter 3 - July --, September Quarter 4 - October --> December Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hazelton, P.O. Box 2009 Stockton, CA 95201 466-6781 UCT 40 10/86 My I hereby certify under penalty of perjury that all inventory variations for the above mentioned facility were within the allowable limits for this q.sarter. (No in Column 13 of the Inventory Reconciliation Sheet) QInventory variations exceeded the allowable limits for this quarter. I hereby certify under penalty of perjury that the source for the variation was not due to an unauthorized (leak) release. (Yes in Column 13 of the Inventory Reconciliation Sheet) List date, tank #, and amount for all variations that exceeded the allowable limits. Date Tank # Amount 2. 3. 4. 5. Additional dates/amoubts shall be continued on a separate sheet of paper and attached. If the source of the variation which exceeded allowable limits was due to a leak the incident shall be reported to S,J,L.H.D. Environmental Health within 24 hours and an unauthorized release report submitted. The quarterly su— ry report shall be Submitted within 15 days of the end of each quarter. Quarter I - January --) March Quarter 2 - April --> June Quarter 3 - July --, September Quarter 4 - October --> December Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hazelton, P.O. Box 2009 Stockton, CA 95201 466-6781 UCT 40 10/86 I hereby certify under penalty of perjury that all inventory variations for the above mentioned facility were within the allowable limits for this q.sarter. (No in Column 13 of the Inventory Reconciliation Sheet) QInventory variations exceeded the allowable limits for this quarter. I hereby certify under penalty of perjury that the source for the variation was not due to an unauthorized (leak) release. (Yes in Column 13 of the Inventory Reconciliation Sheet) List date, tank #, and amount for all variations that exceeded the allowable limits. Date Tank # Amount 2. 3. 4. 5. Additional dates/amoubts shall be continued on a separate sheet of paper and attached. If the source of the variation which exceeded allowable limits was due to a leak the incident shall be reported to S,J,L.H.D. Environmental Health within 24 hours and an unauthorized release report submitted. The quarterly su— ry report shall be Submitted within 15 days of the end of each quarter. Quarter I - January --) March Quarter 2 - April --> June Quarter 3 - July --, September Quarter 4 - October --> December Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hazelton, P.O. Box 2009 Stockton, CA 95201 466-6781 UCT 40 10/86