Laserfiche WebLink
INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: EISCALON MINI-MAFiT Tank f Sise Product <br /> l U ov c <br /> Facility Address: <br /> d <br /> Telephone : <br /> Person Filxkg <br /> Report <br /> I hereby cc ify 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 /> E] Inventory variations exceeded the allowable Limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> vas not due to an unauthorized (leak) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank i, and amount for all variations that exceeded the <br /> allowable limits. <br /> �)+ � <br /> Date Tank f Amount &4X,,//nn W <br /> 11 <br /> 1 ��, 2. 11- 12-97 exce4& Ae � &A' <br /> d4 �� 3. 12--t3. $1 Oar �6»� <br /> 4.0 r714 <br /> ¢5 <br /> 5. 4 <br /> We hofa <br /> Additional dates/amounts shall be continued on a separat sheet of �( <br /> paper and attached. <br /> If the source of the variation whichexceeded allowable limits was due to <br /> a leak the incident shall be reported to S .J .L.H . D. Environmental lieaIth <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 1 - January --) March <br /> Qvactcr 2 - April --) June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --) December <br /> Ji rf: <br /> Send to: V-7 <br /> SAN JOAQU IN LOCAL HEALTH DIS.ITH 1 C1' <br /> 1601 E . I aze 1 t oll , P .O . Box 2009 <br /> Stockton , CA 95201 466-67bl <br /> UCT 40 10/86 =`' <br />