Laserfiche WebLink
1 <br /> INVENTORY RECONCILIATION <br /> ` QUARTERLY SUMMARY REPORT FORM <br /> DATE: - <br /> Facility <br /> aTE: ,Facility Name: E. F. Kludt & Sons, Inc. Tank t Size Product <br /> 1 <br /> Facility Address: 1126 E. Pine Street 2 <br /> California D <br /> Tele )h e : (2(g) 966-063L or G66-8969 <br /> Per'so <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 unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 2. <br /> 3. NOV �t �988 <br /> 4. <br /> 5. ��:2V,-CC 9LTW <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 ,1 .11.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 /> Quarter 2 - April --> June <br /> Quarter 3 - July --) September <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton , P .O . Box 2009 <br /> Stockton , CA 95201 466-6781 <br /> UG1' 40 10/86 <br /> Tiake co-,T (.yellow) for Kludt files and attach Inventory Reconciliation records for <br /> all. tanks. <br />