Laserfiche WebLink
C% INYENYORY RECONCILIATION SEP 281989 <br /> l QUARTERLY SUMMARY REPORT FORM <br /> ENVIRONMENTAL HEALTH <br /> I� � PERMIT/SERVICES <br /> facility Naso: ea 2440/1 f Ud 01/ Tank I Site Product <br /> 00 c <br /> Facility Address: <br /> Telephone : 70% 9�/�/,f'IV <br /> Person Filing <br /> Report 11Z 115, //aD.mu1 <br /> �[ 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 13 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 disc to an unauthorized (leak) release. (Yes in CoLumn 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date. tank /r and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> I. <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 /> ■ leak the incident shall be reported to S . .) . L. H . D. F.nvironorntal 11calth <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 1 - January --) March �� x <br /> Q'iartcr 2 - April --> June <br /> Quarter ) - July __> September 0 <br /> Quarter 4 - October --) December 1% <br /> Send to: SAN .IOAQUIN LOCAL HEAL'I'li DI :i'I'IZIC'I' <br /> I001 E. . Uam- 11 ,111 . 1' . t) h" .: 7110'1 <br /> Slockt.on , CA '15201 4Lc, - Olbl <br /> 111;'I (o1) IWHN <br />