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INVENYORY RECONCILIATION <br /> QUARTERLY SUMMARY RFPORT FORM <br /> Facility Name: /GfTrl�[rolL�n �d�J Tank I Sire <br /> Product <br /> Facility Address: y /17 eLI <br /> In t� <br /> n C `�5itU� <br /> Telephone : <br /> Person Fnp <br /> Report <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 13of 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 unauthorised (leak) release. (Yes in Column IJ of the <br /> Inventory Reconciliation Sheet) <br /> List dater tack /r and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts %hall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of Che variation which exceeded allowable limits was due to <br /> a leak the incident shall be reported to S ) 1 l{ 0 Environmental Ilealth <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 <br /> Q•�a ecce 1 - April <br /> Quarter ) - July __) Scptemher H <br /> S30M35g11&%r 4 - October --) Ih%ember 11 <br /> H11V3H 1V1N3WN02J1AN3 <br /> Send to: SAN .1OAQII I N LOCAL 11EAIA Ii 1)I S'I H I GI' <br /> W1 6 T Nflf 1001 1: . CrIzI• I I (4I . i' t) :.. ; 7OW) <br /> SIockt.on . CA 95201 100. hlbl <br /> �ii n� �(� <br />