Laserfiche WebLink
INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY RF_PORT FORM <br /> Facility Name: GEWEKE FORD R.V. <br /> Tank f Site Product <br /> Facility Address: 248 E. KEIT LEMAN LANE 100— O�GAIS <br /> 550 GA <br /> __Id)DI.Ca LIFORNIA 95240 <br /> Telephone : 209-334-0987 or 209-957-2250 <br /> Person FL�f, <br /> Report A BANNON,OFFICE MANAGER <br /> [nX I hereby certify under peoaLt of <br /> the above w perjury that all inventory variations for <br /> I meacton<d facility were within the allowable Limit+ foe this <br /> I� quarter. (Ho in Columa I3of the loveatory Reconciliation Sheet) <br /> ❑ Inventory variations exceeded the allowable <br /> hereby certify under Penaltyof limits for this Quarter. I <br /> at the <br /> was not due to ao unauthorized (Leak)rreluac. (Yen <br /> InventoryColusnfor ll3 ofVariationle the 'Inventory Reconciliation Sheet) ` <br /> List date. took f, and amount <br /> allowable limits_ for all variations that exceeded the <br /> Date Tank / Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/•mount, .hall be continued on a separate sheet of <br /> Paper and attached. <br /> If the source of the variation whichexceeded allowable limit, was due to <br /> a leak the incident shall be reported to <br /> Within 24 hour, and an unauthorised release report L. H . D.bmiitteda'umcntal Health <br /> The quarterly sumsary report shall be subm <br /> quarter. itted withi IS days Of he end of each <br /> Quarter 1 - January --) March <br /> Quarter 2 - April --) Jul'(! <br /> Quarter ) - July __) gcl,to,I,er <br /> Send to: <br /> Qua r[cr 4 - Octohcr --) Ikcmbcr cIjIVLAV�[J v44� �1i L1 ([[I1'(ttvvJlll�ll'' <br /> SAN JOAQUIN LOCAL HEALI-Ii 01S1-kIC•1- JAN 61989 <br /> 1601 1" . I:;,rt• I 1' . 0 . Itoix 2,09 <br /> ENVIRONMENTAL HEALTH <br /> ICT 40 l0/N6 Stock[on . CA 95201 466 -67b1 PERMIT/SERVICES <br /> . <br />