Laserfiche WebLink
INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility. Nasse: .<lACLOCr Awg!- ,A/ia Ixme <br />FacLlity,Addcess: 76tS-JW0kjre1.+c jex%ox. <br />:. <br />Telephone:(iOyJ 2 3 4-y 10 <br />Person F ing <br />Report � AU/%J 171E1'1) -,El <br />Tank I Size Product <br />/ Z U7lG U./tfnOe06 " <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 1] of the laveacory Reconciliation Sheet) <br />❑ Inventory varisCioas exceeded the allowable limits for this quarter. I <br />hereby certify under penalty of perjury that the source for the variation <br />was not due to an unauthorised (leak) release. (Yes in Column l] of the <br />laveatory Reconciliation Sheet) <br />List dates tank to aad aaount for all variations that exceeded the <br />allowable limits. <br />Date Tank I Amount <br />2. Q� <br />4. <br />5. <br />Additional daces/amounts shall be conciaiked 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 llcalth <br />Within 24 hours and an unauthorised relcase report submitted. <br />The quarterly suassary report shall be submitted within 15 days -of the end of each <br />quarter.I'✓ �'Yf"IIIVJ <br />Quarter I - Januar ch <br />Q��((� <br />Quarter 2 - ril JUL_ 2"r 19 <br />Quarter ) - July -- September 89 <br />Quarter 4 - October --) December <br />ENVIRONMENTAL HEALTH <br />Send co: SAN JOAQUIN LOCAL HEAL1'li UIS'I'H1C1' P IT/SERVICES <br />1601 E. HaZelLnn. P.O. IIQs 2009 <br />LI <br />Stockton, CA 95201 466-6761 <br />Eli 23 019 10/86 <br />