Laserfiche WebLink
INVENTORY RECONCILIATION WONIVIENTAL F `_i <br /> i^ t <br /> QUARTERLY SUMMARY REPORT r•ORri.�RC�:IT� �rof,r„�_ <br /> Facility Name: Tank # Size Product <br /> Facility Address: P12 <br /> Telephone: 'C'L150 <br /> Person Filin 7 <br /> Report: . <br /> ❑ I hereby certify under penalty of perjury that -all inventory variations <br /> for the above mentioned facility were within the allowable limits for <br /> this quarter. (No in Column 13 of the Inventory Reconciliation Sheet. ) <br /> VL <br /> ventory variations exceeded the allowable limits for this quarter. Ireby certify under penalty of perjury that the source for the varia- <br /> on was not due to unauthorized ( leak) release. (Yes in Column 13 of <br /> e Inventory Reconciliation Sheet) . <br /> List date, tank # , and amount for all variations that exceeded <br /> the allowable limits . <br /> Date Tank # Amount <br /> 2 . <br /> 3 . <br /> 4 . <br /> Additional dates/amounts shall be continued on a separate sheet <br /> paper and attached. <br /> If the source of the variation which exceeded allowable limits was <br /> due to a leak, the incident shall be reported to San Joaquin Local <br /> Health District; Environmental Health Division, within twenty-four <br /> ( 24 ) hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within fifteen (15 ) days <br /> of the end of each quarter. <br /> Quarter 1 - January---------->March Apr. 15 <br /> Quarter 2 - April------------>June --u,l 15 <br /> Quarter 3 - July------------->September C>e t!5 <br /> Quarter 4 - October---------->December u�►1 IS <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton, P.O. Box 2009 <br /> Stockton, CA 95201 468-3420 <br /> LII 23 019 10/86 <br />