Laserfiche WebLink
INVENTORY RECONCILIATION OCT bIpq-, <br /> QUARTERLY SUMMARY REPORT FORM ENVIRCMENTAL HEALTH <br /> Carl Karcher Ent. IERMIT/SERVICES <br /> Facility Name: <br /> Facility Address: 'tank i Size <br /> Product <br /> 800 Mellon Avenue l <br /> Diesel 1l2 <br /> 2 550 Diese <br /> Manteca, CA336 <br /> Telephone : 209-823-9251 <br /> Person Filing <br /> Report Terry Langstaff <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 11 of 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 I3 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank E, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank R Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> S. <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 limits was due to <br /> a leak the incident shall 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 --> March . <br /> Quarter 2 - April --> June <br /> Quarter ] - July --) September <br /> Quarter 4 - October --) December <br /> Send cc: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton , P .O . Box 2009 <br /> Stockton , CA 95201 466-678L <br /> UCT 40 10/86 <br />