Laserfiche WebLink
INVENTORY RECONCILIATION <br /> Pr <br /> ECONCILIATIONn <br /> QUARTERLY SUMMARY REPORT FORM <br /> � ; <br /> Facility Name; !7 Tank # Size <br /> Product <br /> P:citify Address: �7 AJ <br /> CJ& <br /> Telephone : <br /> Person Filing ��� <br /> Report y� <br /> I 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 Colu® 13 of the Inventory Reconciliation Sheet) <br /> . i <br /> ❑ Inventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was 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 lia%its. <br /> Date Tank f Amount <br /> i. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which. exceeded at-lowable limits was due to <br /> a leak the incident shall be reported to S .J .L.H . D. Environmental Health <br /> Within 24 hours and an unauthorized release report submitted. <br /> a The quarterly summary report shall be submitted within 15 days of the end of each <br /> quarter. <br /> { Quarter i - January --) March <br /> 1 Quarter 2 - April --> ,lune <br /> i Quarter 7 - July --> September <br /> Quarter 4 - october --> I31--cember <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 160L E. Hazelton , 11 .0 . 11Ox 2001) <br /> Stockton , CA 95201 466-6761 <br /> UCT 40 10/86 <br />