Laserfiche WebLink
INVENTORY RECONCILIATION <br />�v QUARTERLY SUMMARY REPORT FORM <br />Facility Name: c .-/1 c <br />Fac. ity <br />Telepho <br />Person <br />Reporr <br />❑ I hereby certify under penalty of perjury that all inventory variations for <br />the above mentioned facility were within the allowable limns fo <br />quarter. (No in Column 13of the Inventory Reconciliation <br />'Nt <br />i V LJ <br />OCT 17 <br />Inventory variations exceeded the allowable limits for 1 1991 <br />} <br />hereby certify under Penaltyofthe T �.. L�-. <br />was not due to as unauthorized (leak)rrelease. (YesuineColumn 1rofts <br />Inventory Reconciliation Sheet) 3 �f t e <br />List date, tank #, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank # Amount <br />2- <br />3- <br />4. 3.G. <br />.ldditional da[eS/amount; shall be continued on a separate sheet of <br />Paper and attached. <br />If the source of the variation which exceeded allowable lisai <br />a leak the incident shall be re;pdrted to ts was nue to <br />Within 24hours and an unauthori{ed release reportt IbmittedOn�ntal 11ca1th <br />The quarterly Sumasary report shill br <br />quarter. submi[ted wi[hin IS d,,y; ot the end of r.tch <br />Quarter I - January Narch <br />Q•iarter - April <br />a rte - July --> ';c��tcmher <br />Qii-arter (. - October --> Ih-comber <br />Jcnd CO: SAN JOAQUIN LOCAL. HEALT'Fi DISTRICT <br />1601 F. Hazelton , p.0. Box 2009 <br />[ICT 4010/86 Stockton, CA 95201 466-6781 <br />