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COMPLIANCE INFO_1987-1992
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0231801
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COMPLIANCE INFO_1987-1992
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Last modified
11/8/2022 4:37:59 PM
Creation date
6/23/2020 6:52:31 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
1987-1992
RECORD_ID
PR0231801
PE
2361
FACILITY_ID
FA0003290
FACILITY_NAME
COUNTRY MART GAS & FOOD
STREET_NUMBER
34243
Direction
S
STREET_NAME
CHRISMAN
STREET_TYPE
RD
City
TRACY
Zip
95304-9334
APN
25318004
CURRENT_STATUS
01
SITE_LOCATION
34243 S CHRISMAN RD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231801_34243 S CHRISMAN_1989.tif
Tags
EHD - Public
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1756V7 INVENTORY.RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM APO <br />�ONMENT" <br />Facility Name: <br />ra.1 Al <br />Tank <br />Facility Address: <br />Telephone: <br />Person Fili <br />Report: __A <br />I hereby certify under Penalty of perjury that all inventory <br />variations for the above mentioned facility were within the <br />allowable limits for this quarter. (No in column 13 of the <br />Inventory Reconciliation Sheet.) <br />Inventory variations, exceeded the allowable limits for this <br />quarter. I hereby certify under penalty of perjury that the <br />source for the variation was not due'to authorized (leak) <br />release. (Y—es in Column 13 of the Inventory Reconciliation <br />Sheet). <br />List date, tank 1, amount for all variations and the reason <br />for exceeding the allowable limits. <br />M;m <br />1. <br />2. <br />3. <br />4. <br />5. <br />Tank g. <br />mount <br />AdditionalAdditional dates/amounts shall be continued on a separate <br />sheet of paper and attached. <br />If the source of the variation which exceeded allowable limits <br />was due to a leak, the incident shall be reported to Public <br />Health Services of San Joaquin County Environmental Health <br />Division, within twenty-four (24) hours and an unauthorized <br />release report submitted. - <br />The quarterly summary report shall be submitted within fifteen (15) days of <br />the end of each quarter. Circle appropriate quarter. <br />Quarter 1 - January----- >March <br />Quarter 2 - April ----------- >June <br />Quarter 3 - July ------------ >September <br />Quarter 4 - October --------- >December <br />Send to: SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />1601 E. Hazelton Ave., P.O. Box 2009 <br />Stockton, CA 95201 <br />(209) 468-3420 <br />
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