Laserfiche WebLink
i <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility, Name: 1cTOCK-f0ty �L?X C iN��,SUk61w8n+tj fAKkM AaF Ftlrenr?�Ni'rtitty t1:n� <br /> 4�. n Ik Size. <br /> Product July, <br /> FAcility-Address: X140 , ChuR �,e� ft7 00� E6UL <br /> ID moo• . <br /> q9ZGL) 3S <br /> Telephone : 6: Lo <br /> apo c01'�A Un GAA <br /> Person Filing �� i2sRC Alegi td <br /> Report <br /> �I hereby certify under penalty ofer'urya <br /> t all tins <br /> the above Mentioned facility were within theallowable climitsvfor athis for <br /> quarter. (No in column 13 of the Inventory Reconciliation Sheet) <br /> Y, <br /> El <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 CO as unauthorized (leak) release. (Yes in Column 13 of the <br /> ' Inventory Reconciliation Sheet) <br /> List date, tank /, aad amount for all variations that exceeded the <br /> Allowable lignite. <br /> A <br /> Date tank f Amount O11✓L -rA� / 0 �YlYfr <br /> 1. <br /> 2• — 0Y ZS p �U le- <br /> 9 sr? <br /> y <br /> 3. �o j 2Ss 9 SYv <br /> 4. <br /> Additioaal daces/amounts shall be continued on a 'se• <br /> Paper .and attached. Pa rate ghee[ o E <br /> [E the source of the variation which exceeded allowable limits was duc to <br /> Leak the incident shall be reported to S .J . L. H . Q. Environmental Health <br /> within hours and an unauthorized release report submitted. <br /> The Quarterly summary report shall be RubmiCced within IS days of the end of each <br /> Quar(cr. <br /> Quarter I - January --) March <br /> Q,aac 2 April --> June <br /> Quarter - July --> Septemht:r <br /> NAarter 4 - October --) 0ecemher <br /> Send to: SAN JOAQU IN LOCAL HEALTH DIS-1-RIC-1- <br /> 1601 <br /> IS-1-RIC"1'1601 E. Eiaze l*r,n , 1' .O. Box 2009 <br /> tit ockton , CA 95'201 466 -6761 <br />