Laserfiche WebLink
►AYENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> OCT 1 G 1999 <br /> Facility Name: TankE� C <br /> T/ <br /> Facility Address: avi <br /> o*AA) 1,93 <br /> Telephone : / <br /> Person Ii g <br /> Report ' <br /> E] 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 Coluasn 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, taak 1, and amount for all variations that exceeded the <br /> allowable Lic,its- <br /> Date Tank f Amount <br /> 1. <br /> 2- <br /> 3. <br /> 4_ <br /> 5_ <br /> Additional dates/amouacs shall be continued on a separate sheet of <br /> paper and attached. <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 /> Midrin 24 hours and an unauthorized release report submitted. <br /> I'he quarterly summary report shall be submitted within 15 days of the end of each <br /> quarter. <br /> Qu%.rtcr I - January --) riarch <br /> Quarter 2 - April --> Jure <br /> Quarter 3 - July --> Scptcmhc-r <br /> Quarter 4 - Occober --> I>ccrmber - <br /> Scnd co: SAN JOAQU IN LOCAL HEALTH U i S•C{t I CT <br /> 160L K. Hazelton . P .O . Hom 2009 <br /> SLockcon . CA 95201 466 -6781 <br /> LILT 40 10/ 80 <br />