Laserfiche WebLink
INVENTORY RECONCILIATION • <br /> QUARTER <br /> L <br /> Y <br /> SUMMARY REPORT FORM <br /> Facility Name. 43 P f�gFtiIAJU�� l3 Tank / Size Product <br /> Facility Address: Aj�y% [��dc�- �D✓J Gni/�a/eA <br /> „(an:2Y<,ff-, yrs 9f Z 6 __ _ 3�_ ��OJJ t?eCi <br /> Telephone : 9yl -010i/ '� - �T.Ato 4?yZj <br /> Person Filing <br /> 1/I I hereby certify under penalty of perjury that all Inventory variations for <br /> rX\— 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 thin 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 IJ of the_ <br /> Inventory Reconciliation Sheet) <br /> List date, tank 1, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/nmounts shall be continued on a separate khect of <br /> paper and attached. <br /> If the snurce of the variation which exceeded allowable limits was due to <br /> a Irak the incident shall be reported to S .J .l..11 . D. F.nvi roll mcntaI Ilealth <br /> within 24 hours and 8n unauthorized release report submitted. <br /> the quarterly summary report shall be kubmitted within 15 days of the rnd of each <br /> quarter. <br /> fh,arter 1 - Jamiary --) Hnrch <br /> friarter 2 - April --> June <br /> plarter 3 - July --> September <br /> Quarter to - October --> December <br /> - j � <br /> Send to: SAN JOAQUTN LOCAL IIIiAI;I'll <br /> 1601 E . Hazelton , 1' .0 . flux 2009 FEB 2210-89 <br /> SLo(+I-on , CA 95201. 666-6781 <br /> ENVIROW—NTAL HEALTH <br /> u(;,r 6U 10/86 �ERh".!' 1 fl,LWIC=; <br />