Laserfiche WebLink
INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM ENVIROWZ ITALHEALTH <br /> PERMITISERVICES <br /> Facility Name: CApMp(]rF cvna Tank f Stze. Product <br /> 1000 GAL UNLEAD GA. <br /> Facility:Address: _18600 CORRAL HOLLOW RD 2 ' 1000.GAL DI <br /> 1 _TRACY CA 95378 01105 <br /> Telephone : 415 455 5918 <br /> Person Filing <br /> Report N(1RM FC RTFR <br /> QI 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 /> bereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) relelse. (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 limits. <br /> Date Tank a Amount <br /> 1. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amount= shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which. exceeded al•lowabLe limits was due to <br /> a leak the incident shall be reported to S.J AL.H.D. Environmental Health <br /> within 24 hours and an unauthorized release report submitted. <br /> The Quarterly summary report that[ be submitted within 15 days of the end of each <br /> Quartet. <br /> Quarter 1 - January --> March <br /> Quarter 2 - April --> June <br /> arter 3- July --) September <br /> Quarter 4 - October +-> fh comber <br /> Send to: i SAN JOAQUIN LOCAL HEALTH UIS'1'Rlcl' <br /> 1601 E. IlazelLe'll . 1' .0 . IIOM 2009 <br /> SLockton . CA 95201 466-6761 � <br /> T 40 10/86 <br />