Laserfiche WebLink
INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: r- <br /> �- Tank f Size <br /> Product <br /> FAcility�Address: <br /> Telephone : <br /> Person Filing <br /> Report <br /> EI 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 /> Inventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> vas not due to so unauthorized (leak) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank /, and amount for ail variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount �!�� <br /> 1, r' <br /> z. F ApR3. <br /> � (v(rV <br /> 4 FFR VP SF 4 H�j <br /> S. R�j�Fs�Th <br /> Additional dates/amouata 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 /> The quarterly summary report shall be Rubmitted within 15 days of the end of each <br /> quarter. <br /> Quarter I - January --> March <br /> Qlarter 2 - April --) June <br /> Quarter 3 - July --> Scptcmhcr <br /> Quarter 4 - October --> (kecmbcr <br /> Send co: SAN JOAQUIN LOCAL HEAL1'1i DISTRICT <br /> 1601 B . HazelLlnl , P .O . R()r 2()09 <br /> 11CT 40 10/86 SLockton , CA 95201 466-678L <br />