Laserfiche WebLink
INVENTORY RECONCILIATION"' <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Horron'c cat M r Tank R Size Product <br /> 6,000 U/L Premium <br /> Facility<Addresa: 13475 N. Jacktone Rd 715 10,000. U/L Regular <br /> E. Lodi, CA 95240 _ 731 '12 000 Re ular <br /> Telephone : (2 9) 368-7669 <br /> Person Filing <br /> Reporc 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. (Ho in Column 13 of the Inventory Reconciliation Sheet) <br /> E3Inventory variations 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 unauthorized (leak) release. kXxxxaaaXtX4gkxx4�le <br /> v'Y'Yx ]QXk-1)7C7C�}( (Based on daily measurement error only. ) <br /> List date. rank E, and amount for all variations chat exceeded the <br /> allowable limits- <br /> Date Tank I Amount <br /> 1. SEE ATTACHED INVENTORY CONTRnT, SiAFFTs <br /> 2_ ASTERISKS DENOTE VARTATIQMS FSCFFnTNQ 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 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 /> Quarter 1 - April --> June <br /> Quarter 3 - July --> Septemher <br /> Quarter 4 - October --) December <br /> Scnd Co: SAN JOAQUIN LOCAL HEALTH OIS'1•li1C"F <br /> 1601 E. Ha7.0 I Loll . P .O . cox 20()9 <br /> Stockton . CA 95201 466 -676L <br /> UCT 40 10/86 <br />