Laserfiche WebLink
*INVENTORY RECONCILIATION • <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Ham': <br /> _e I_[1�C Tank I Size Product <br /> Facility Address: ASO 0 1 a PS <br /> mc,r � <br /> .�?u.vic-ca Ca 953' <br /> Telephone : (2La� 239 _ lDO <br /> Person Fi, ing <br /> Report � �n L <br /> �c <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 IJof 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 /> was not due to an unauthorized ( leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliarion Sheer) <br /> List date, tank I, sud amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank t Amou❑t <br /> J. <br /> 4. OCT 5 1988 <br /> 5. <br /> E^JVIRQNMF.NTAI. F!fiAITM <br /> PERMIT/SERVICES <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 al-lovable limits was due to <br /> a leak the incident stall 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 Harch <br /> Q"arter 2 - April --> June <br /> Quarter ] - July --) September <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . Hazelton , P . O Box 2009 <br /> UC'C 40 10/86 Stockton , CA 95201 466-6781 <br />