Laserfiche WebLink
INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> C- P - <br /> Facility Name; 'Tank # Size <br /> Product <br /> Facility,Address: X530 <br /> Telephone : Q�8_ 7Z <br /> Person TM qZ <br /> Report ��';• <br /> j I hereby certify under penalty of perjury that all inventoryvaria <br /> tio <br /> ((( the above mentioned facility were within the allowable lims for this for <br /> quarter. (No in Column 13of the Inventory Reconciliation Sheet) <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 f, and amount for all variations that exceeded the <br /> allowable licnits. <br /> Date Tank f Amount <br /> 1. <br /> 2. RON C IV` F" <br /> 3' JAN 16 1999 <br /> 4. �,NVIRONMENIAL HEALTH <br /> S- -ERMITIERVIUS <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 allowable 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 />_j The Quarterly summary report shall be submitted within 15 days of the end of each <br /> 1 quarter. <br /> Quarter I - January --1 March <br /> Quarter 2 - April --> June <br /> i Quarter 3 - July --> Scptemhi�c <br /> Quarter 4 - October --> [kccmber <br /> Send to: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . Haze 1 t o�tl , 11 .0 . Eic�x 2009 <br /> Stockton , CA 95201 466-67b1 <br /> UCT 40 10/86 <br />