Laserfiche WebLink
_ - -- -- _-._ ------ -- IVC-- --- <br /> INVENTORY RECONCILIATION <br /> APR 2 2 1992 <br /> QUARTERLY SUMMARY REPORT FORM <br /> ENVIRONMENTAL'HEALTH <br /> /f PERMIT/SER IDES <br /> Facilaty, Name: \f ll v1 , � � r Yank f Site pr duet <br /> r.citicy Aeare..: -1-7 �( fV, 641 ��iJ W n N u <br /> Telephone : �L` o <br /> 41141 <br /> Person Filin <br /> Reporc G« I-} O � -�14Lop�fC' <br /> frl • 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 13o( the foveatory 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) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank to sad amount for all variations that exceeded the r <br /> allowable limits. <br /> Date Tank f Axoount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amouata shall be continued on a separate sheet of <br /> paper and attached. <br /> Lf 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 Iloalch <br /> within 24 hours and an unauthorised 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 I - July --> September <br /> Quarter 4 - October --) Ikaccmber <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. IiazelLon . P .O . Rox 2009 <br /> Stockton . CA 95201 466-67bl <br /> EH 23 019 10/86 <br />