Laserfiche WebLink
INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Size Produet <br /> Facility Address: 11,Wg ok .7— <br /> Telephone : <br /> 7—Telephone : J`i y,J _aA <br /> Person FL/1�1 g <br /> Report �F 2- 4;14 <br /> OrI hereby certify under penalty of perjury that nit inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> quarter. (Ho in Columb 19 of the Inventory Reconciliation Sheet) <br /> E] Inventory 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. (Yes in Column I] of the <br /> Inventory Reconciliation Sheet) <br /> List lintel tank /o and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 1. <br /> 2. <br /> ]. <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 limit.^, vas due to <br /> ■ leak the incident shall be reported to S .J .1_11 . 1) , F.nvirow,entnl IicaltI <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 — Jannary --) Narch <br /> friarter 2 — April --> .lune <br /> t July --) September <br /> QAarter 4 — October. --> December <br /> Send to: SAN JOAQUIN LOCAL 11LA1;1.11 DIS'l•ItIC'1' <br /> 1601 E . II17clL011 , P .O . 11" 7.009 <br /> Stockton , CA 951701 466-6781 FEB 221989 <br /> uc•r 4o 10/86 <br /> ENVIRONMENTAL HEALTH <br /> PERK(/SERVICES <br />