Laserfiche WebLink
C111iCY. LIST <br /> Facility Name: 8eq� <br /> Tank#: _ , 4izc: 600c_-) Product: <br /> The allowable variation was exceeded. Date/Time: _ 1F9y 3 -- <br /> i <br /> Check off each step as it is completed. <br /> If completion of any of the steps reveals the reason for exceeding the <br /> allowable variation it is not necessary to complete the remainder of the <br /> steps. <br /> Step l- � Records Reviewed Date/Time: <br /> Performed By: i a4_4" <br /> Step 2- New Reconciliation Date/time: S-9 - S°/ 3• `30 =ti <br /> Performed Performed By: <br /> Step J- E] Tank Owner Notified Date/Time: <br /> Performed By: <br /> Step 4- El Records Reviewed from Date/Time: <br /> Last 0 Balance (Must Performed By: <br /> be performed by qualified <br /> person) <br /> Step 5- Facility physically Date/Time: <br /> Inspected for Evidence Performed By: <br /> of Leaks <br /> Step 6- Calibration on Dispenser Date/Time: <br /> Meters Checked Performed By: <br /> (Complete Neter <br /> Calibration Check Form) <br /> Step 7- Hydrostatic Pressure Test Date/Time: <br /> on Piping Performed Performed By: <br /> Step 8- Precision Tank Test Date/Time: <br /> Performed Performed By: <br /> (Provide results to SJLHD <br /> Environmental llealth) <br /> Step 9- Follow-up investigation Date/Time: <br /> as required to be per- Perfort:ed By: <br /> formed by SJLHD . <br /> Describe briefly the erreajson the allowable variation was exceeded: <br /> � <br /> I Hearby Certify this is a True and Accurate Report. <br /> Signature/Date: /�? p"�`� s7 ��� <br /> Attach this report to Inventory Reconciliation Sheet where allowable variation <br /> was exceeded. ` <br />