Laserfiche WebLink
VENTORY RECONCILIATION S + C }� (ro <br /> QUIOERLY SUMMARY REPORT FORNiWDf <br /> ��� <br /> Facility Name: We- I Tank if i Size 1 Product <br /> I D Oen �E�EI-- <br /> Facility Address: 2427 y�oMkf� <br /> Telephone: Z BZ3 r ! <br /> Person Filing <br /> Report: M 1� � 1'��1 -7Sl� 8908 <br /> I hereby certify under penalty of perjury that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quarter. (No in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> Inventory variations exceeded the allowable limits for this <br /> quarter. I hereby certify under penalty of perjury that the <br /> source for the variation was not due to authorized (leak) <br /> release. (Yes in Column 13 of the Inventory Reconciliation <br /> Sheet) . <br /> List date, tank #, amount for all variations and the reason <br /> for exceeding the allowable limits.. <br /> APR 2 0 L1,2 Date Tank Amount Reason <br /> ENV <br /> R <br /> -x-59 fru . <br /> 2 . 6 Z-01-92 + <br /> 3 . ()Z-C41 gZ — 1.4 <br /> 4. DZ.- 14-qZ k +140 1 c►5+� nn rr e <br /> 5. 1 � 7au'JEr�.`f <br /> 6. MS�n►t <br /> Additional dates/amounts shall be continued on a separate <br /> sheet of paper and attached. <br /> If the source of the variation which exceeded allowable limits <br /> was due to a leak, the incident shall be r. enorted to Public <br /> Health Services of San Joaquin County Environmental Health <br /> Division, within twenty-four (24) hours and an unauthorized <br /> release report submitted. <br /> The quarterly summary report shall be submitted within fifteen (15) days of <br /> the end of each quarter_ Circle appropriate quarter. <br /> �2 Quarter - January---------->March <br /> Quarter 2 - April ------------>June <br /> Quarter 3 - July ------------>September <br /> Quarter 4 - October --------->December <br /> Send to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Iton-,Ave-. , P.O. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 468-3420 <br /> EH 23 019 (10/89) <br />