Laserfiche WebLink
INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Tank P Sise Pc vcc <br /> Facility Address--kT–F—` 1 <br /> Telephone : <br /> Person Fil n <br /> Report 11 dylkeAl Ti-, <br /> r <br /> (0/1 hereby IrKcily under peaalq of pec jury 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 /> DInventory 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 uaauthorixed (leak) releise. (Yes in Coln 13 of the <br /> Inventory Reconciliation Sleet) <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Sank ! Amount <br /> 2. OCT 16 1989 <br /> 3- EN V;120N <br /> PERMIT I' <br /> 4. SN VICES L I H <br /> 5. <br /> Additional daces/amauats shall be continued on a separate sheet of <br /> paper and attached• <br /> Lf the source of the variation uhich. exceeded allowable limits was due to <br /> a leak the incident shall be reported to S .J .L.H.D. Environmental Uealch <br /> Within 24 hours and an unauthorized release report submitted. <br /> The Quarterly summary report shall be mubmic.ted within 15 days of the end of each <br /> Quarter. <br /> Quarter I - January --) March <br /> Quarter 2 - April --> June <br /> C Quarter 3 - July --> Scptcmber <br /> Qaartcr 4 - Occo cr -- •ccmbcr <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTKICT <br /> 1601 E. IlazelLoll , P .O . Box 2009 <br /> Stockton , CA 95201 466-67b1 <br /> EH 23 019 10/86 <br />