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F.a^_il lry Nam+. , JEMCO cardlock _ <br /> � <br /> Facility �,,�,dreas. 10414 'Waterloo Rd .� 1 �.��--� water•lo, �'���?�'� �� - <br /> Telephone; _ - <br /> Person F f l ing ------�w e o . <br /> Report : �-- Regula <br /> :5 <br /> z hereby certify under penal-:y of er; TA <br /> �'���".9!T SEf� CES <br /> DX vari 4io.�s }. P ,dry <br /> that al! in armory <br /> �o the abaue mentioned facility were within he <br /> allowable limits for this quarter. (IQ ?r ool; mn 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> Inventory ,variations exceededt�:�k - allowable limits Zor this <br /> quarter. I hereby. ceytify under penalty of re�'j'�ry �1~sa} the <br /> soQrco f" the variation was not due to au�,t4orizal (hake <br /> release, (`•k3 in Colo n 13 of the Yisv"ary Reccncilia_ion <br /> sheet) . <br /> List dater tank #, amount for ail variatinPs and the reason <br /> fOr exceeding the allowable limits. <br /> Lot <br /> Ta .k r,o Re-- <br /> 1. <br /> 3 . <br /> 4 . <br /> 5. <br /> Additional datesfamount.s shall die Continued or, a separate <br /> sheet of ,aper and attached. <br /> 1f the SOW= of the variation Which exceeded allowable limits <br /> wasp ��.��nto a leak, the incident 2ha?l Le reported to rablic <br /> Health .:��,�y'Vic" Of San Joaquin County Invironmentai. Health <br /> Divisic , within twinty-four (24) hours and an unauthorized <br /> release report submitted. <br /> The quarterly s uszarY rapozo shall be s '� <br /> utJ�i r tedaw <br /> t a and o each 1uar e r, Circle appropr � +��.i:l:li� fifteen (I:J) L`a?yS <br /> ate quarter, <br /> Quarter 1 uanuary---------->March <br /> ?lari Pte_ 3 - �t4 y ------------>September <br /> SERVICES <br /> WITH DIVISION <br /> 1601 E. EaZllton Ave. , P. O. Box <br /> 2009 <br /> Stocktcn, Ch 95ZO: <br /> 23 (209) 463-3420 <br />