Laserfiche WebLink
6D 0 0 goin"XV <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM OCT 1 5 1992 <br />ENVIRONMENTAL HEALTH <br />Facility Name: <br />Facility Address: GREWAL'S GAS & LIOUOR <br />4100 E. FHE?o!9N-P6T- <br />Telephone: 3 > 1Z 2Z <br />Person Fi 'ng <br />ReportCL <br />Tank f Siz ct <br />O <br />L 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 />QInventory variations exceeded the allowable limits for this quarter. I <br />hereby certify under penalty of perjury that the source for the variation <br />vis not due to an unauthorized (leak) release. (Yes in column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tack 1, and amount for all variations that exceeded the <br />allowable limits. <br />Date <br />1. <br />2. <br />3. <br />4. <br />5. <br />Tank Amou5re" <br />Additional dates/amounts shall be continued on a separate sheet of <br />paper and attached. <br />Lf the source of the variation vhich.exceeded allowable limits was due to <br />a leak the incident shall be reported to S . J . L.H.D. Environmenta l lica l t h <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 />Qlartcr 2 - April --) June <br />Quarter 3 - July --> September <br />Qiarter 4 - October --) December <br />Send to: SAN JOAQU LN LOCAL HE:A1.1'1i DISTRICT <br />1601 E. Haze 1 t (m . P.O. K,)x 'IIIc)'► <br />Stockton, CA 95201 <br />tic -1. 40 1 ()/ HO <br />Z <br />