Laserfiche WebLink
INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />FaciLlty Name: CAL1,FWAjiI4 N/C,&INY' 17OM404 <br />FacilLtr,Address: 38SLv1 STdW)4ANT1iMr <br />S714PY CA 95376 <br />Telephone: 201 - 835- 89ZO <br />Person Filing <br />Report /(.G(1, In/LL/C14N yGGZ <br />Tank i Size Product <br />G-/ z 00 G L/NL,c G G <br />19 L hereby certify under penalty of perjury that all inventory variations for <br />the above nencioned facility were within the allowable limits for this <br />quarter. (No in Column 13 of the Inventory Reconciliation Sheet) <br />E] Inventory variations exceeded the allowable limits for thin quarter. I <br />hereby certify under penalty of perjury that the source fcr the variscion <br />was not due to an unauthorized (leak) release. (Tea in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank i, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank f Mount <br />3. <br />4. <br />S. <br />Additional dates/aaounta shall be continued on a e-paraee &:vett of <br />paper and aetached. <br />If the source of the variation which -exceeded allowable lio n s wam duc 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 rcpart sub.ieted. <br />The quarterly suo , ry report shall be submitted within 15 day3 of the end of each <br />quarter. <br />Quarter I - January --) March <br />Quarter 2 - April --> June <br />C:Esteer - July --> September /?87 <br />'Tuanter 4 - October --> December <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Hnzcltrnl, P.O. Box 1009 <br />Scockron, CA 95101 466-67bL <br />T 40 10/86 <br />