Laserfiche WebLink
TtaF' — 1 a=� — TI_IE 1 4 :-: t OGRE PETROL- E I P 03 <br /> J <br /> INVENTORY RECONCILIAT40N <br /> QUARTERLY SUMMARY REPORT FORM <br /> ra;elceea -- <br /> rank # Size e _ Product <br /> ie ien�nr7a • � ' <br /> wi ortrt pi ,y <br /> n 1 bfrebv cer'ts fv Oder r <br /> penalty o� rjury that all ir�vcntory variatit+ps for <br /> t``e a`•ove faentioned facility, were within the allowable Limits for this <br /> titettr. (No in Column 13of the laveatory itetoaciliaciort Sheet) <br /> lv--,nntory variazioes exceeded the allowable 'limits for this quarter. I <br /> tom....--tQy certify un-der peaalcy of perjury that the source for the variatina <br /> - vc-t dose to as tgnsuthorized a leak) release. (Yes in Column 13 of the <br /> ....... <br /> TV-jR==pry R4cov4nlistioa Sheet) <br /> Leat data, tack- t; and as�:unt for all variation.a that exceeded the <br /> allowable liptita. <br /> Date Taok # Mouut <br /> I. <br /> Z. �'�-1 L=.��. •�'` .moi t� �.�� .�- `�-�`s�'4•.�..•�_ <br /> 4. <br /> ID <br /> Additio4al dates/amouots shall be continued on a separate sheet of <br /> paptx and attacbsd. <br /> If tS e source of the variatiao which exceeded allowable litaits was d,!c to <br /> 1-Ak the iacidenc shall be reported . to S ,J .L,H,p. bavironcaenGal Vc-alth <br /> _-"== 24 houre ,A an unauthorized releasa report submitted. <br /> The s"21te-iy nus ey rtPorr sha11 be submitted within 15 days of the end of each <br /> • quarter. <br /> Quarter 1 - January March <br /> Quartet 2 - April --> June <br /> Q+artec 3 - July --> September <br /> Quarter 4 - October --y Dcccmher <br /> mac Co. SAH JOAQUIN LOCAL HEALTH DISTtt�CT <br /> 1601 E . Hazelton , P . 0 , Box 2009 <br /> Stockton , Cts 95201 466-6781 <br /> UCT 40 10/86 <br /> r <br /> J <br />