Laserfiche WebLink
IN"^NTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> f,/M M A fLkK- r Tank# Size Product <br /> Facility Name:--7Y / / z / !; , <br /> Facility Address: g571 R cow ro -2 - <br /> ,w Z F l NL <br /> Telephone: 2t� ) — <br /> Perscn FiluV <br /> Report: <br /> 0 I hereby certify 'Under pemalty oi perjury that all inventory variations for <br /> the above mentioned facility were within the allowable Limits for this <br /> quarter. (No in column Ilof the inventory Reconciliation Sheat) <br /> (3Ievemtocy variatibos exceeded the allowable limits for this quarter. ' t <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to as unauthorized (Leak) releiae. (Yat In Colon 1] of the <br /> Iaveatory Recoscilistion Sheet) <br /> List dates tank to and amount for all variations that exceeded the <br /> allowable limits. <br /> Date lrlyl Tank # moo <br /> Z. `1A—h� <br /> 4 <br /> 5::::1L-/.S <br /> �- Z.� . -t !53 <br /> 6. 2. <br /> 7. - <br /> 8. -7= <br /> 10. to - # <br /> tt tv <br /> 11. l3 - A- <br /> 12. <br /> 12. 1`s- -Z 1 - LGS <br /> 13. 22 z� # 1 �r'qZ <br /> 14.x_ <br /> 15. <br /> 16. <br /> 19. 44 11 <br /> X44 <br /> 21. 2h "ZG �2 h21 <br /> 22. q- t <br /> 23. <br /> 24. <br /> 25. <br /> 26.`_ <br /> 27._____ <br /> 28.x_ <br /> 29. <br /> 30. . <br /> 31. <br /> AddLeiooel dacaa/amounts shall be continued on a separate sheat of <br /> paper and attached. <br /> If the source of the variation which exceeded al•lowablelimits was dueeto <br /> a leak the incident shall be reported to S,J .L.H.D. E <br /> within 24 hours and an unauthorized relcaae report submitted. <br /> 1M quarterly summary report shall be submitted within 15 days of the and of each <br /> quarter. y <br /> 3'S <br /> Quarter 1 - January --> Match � F <br /> Quarter 2 - ApriI --> June <br /> Quarter 3 — July --> September APR 1 2 1991 <br /> Quarter 4 - Occobar --> December tNVI! NIENTAL HEALTH <br /> SAN JOAQUIN LOCAL HEALTH DIS'l'N1CT PERK T/SEFMCSS <br /> 1601 E. Hazcleun . 1' .0. Jinx 2009 <br /> Stockton . CA 95201 466-6761 <br />