Laserfiche WebLink
r <br /> RECEIVED <br /> JAN 0 6 1992 <br /> INVENTORY RECONCILIATION ENVIRONMENTAL HEALTH <br /> QUARTERLY SUMMARY REPORT FORM PERMIT/SERVICES <br /> lac.4 ty. Name: m1pm /�� Tank Size Product <br /> / /O coo /�— <br /> lacility'-Address: iia N. �4/.,l�,�,,,cL jo 000 . <br /> ,,IL <br /> Jfk n_, CA 45-4 a,q /Cd 010✓ <br /> Telephone : --ZOq_ 9y/- 2 6, (9 y <br /> Person Filing <br /> Report T nne Sccy;l/� <br /> 0 I 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 13 of the Inventory 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 unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank E /Amount <br /> 1. /v--.6-- 9/ l —/� 7 <br /> 2- —/o & - 9) <br /> 3. fin _ // - I/ / 93 <br /> 4. /0 --�3 - 9/ / '�- /SS <br /> S. /0 ?7 -9/ <br /> Additional dates/amounts shall be continued on a separate sheet of / <br /> paper and attached. 1 <br /> If 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 Health <br /> Within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter 1 - January --) March <br /> Quarter 2 April --> June <br /> Quarter 3 - July > .Septcmbi:r <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQUIN LOCAL HEALTH UISTKICT <br /> 160L E-. Ilaze 1 L o►il , P .O . Rox 2009 <br /> Stockton CA 95201 466-6761 <br /> T 40 10/86 <br />