Laserfiche WebLink
INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name; CO Tank t <br /> Size Product <br /> Facility Address; ( 1 -311 / 000 <br /> Telephone : <br /> Person Filing \ <br /> Report D « .>✓ Items �j <br /> I 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 /> C1Inventory variations exceeded the allowable limits for this Quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was oat due to an unauthorixed (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date. tank /r and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amouats shall be contioued 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 submitted within 15 days of the end of each <br /> Quarter. <br /> Quarter I - January --) March <br /> Q jarter 2 - April --) June <br /> Quarter ) - July --) ;eplember <br /> Quarter 4 - October --) Ihcember <br /> Send to: SAN LOCA .INEAL'1'li Ul :i'I'IlI(:I' <br /> I f,O 1 F . I!:1zt. 11 "11 . P . 0 :..s /1111'1 <br /> Stocktofi . CA 95201 466 -67bl <br /> UCT 40 10/H0 <br />