Laserfiche WebLink
INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Horton's ons Mart Tank I Site Product <br /> 6,000 U/L Premium <br /> Facility,'Address. 13475 N. Jacktone Rd. 715 10,000. U/L Regular <br /> E. Lodi, CA 95240 .731 12 000 <br /> Regular <br /> Telephone : (209) 368-7465 <br /> Person Filing <br /> Report Joe Sanzo <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 13of the Inventory Reconciliation Sheet) <br /> © Inventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> vas not due to an unauthorized (leak) rele"e. kXiexx)tnx9Rtwmx1Ax9[KxKhx <br /> YY }E7dXY� XR 'ZdY�Y'i7LY�1X7474X1CR�}� (Based on daily measurement error only.) <br /> List date. tank /, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> I. SEE ATTACHED INVENTORY CONTROT, STarrTS <br /> 2. ASTERISKS DENOTE VARIATIONS i'xcrrnTNG ALLOWABLE LIMITS. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation whichexceeded 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 /> Quarter 2 - April --> June <br /> Quarter 3 - July --> Scptemhcr <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> L60L E . HazelLo n , F .O . liox 2009 <br /> Stockton . CA 95201 466 -6781 <br /> UCT 40 10/ 86 <br />