Laserfiche WebLink
INVENTORY RECONCILIATION OCT 1 ;31989 <br /> QUARTERLY SUMMARY REPORT FORM <br /> ENVIRONMENTAL HFALTH <br /> PERMIT/SERVICE- <br /> FaciLity Hamel P/� �(p Tank i Size. <br /> Product <br /> Facility�Addressz � /� /►rte �t�/i�OTn/C� /� <br /> L' <br /> Telephone : 1' 2- C L11-2- r 4/ <br /> Person Fili <br /> Report ! %�/c_t�n ._ f�i✓; /l <br /> ❑ 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 as unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank /, and amount for all variations that exceeded the <br /> allowable licnits. <br /> a <br /> Date Tank f Amount <br /> 2. <br /> 3. <br /> 4. <br /> / /�'r✓ <br /> s. 4X <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation whichexceeded 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 IS days of the end of each <br /> quarter. <br /> Quarter I - January Harch <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October Bvicember <br /> Send to: SAN JOAQUIN LOCAL HHAL1'li DISTRICT <br /> 160L I: . Hazelton . P . 0 . liox 2000 <br /> Stockton , CA 95201 466 -6781 <br /> Ic;T 40 10/ 86 <br />