Laserfiche WebLink
INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> �/ ENVIRUME��7AL HEALTH <br /> F.cilltr Name: TOC kfoN / (:X a ra��,su�61weNr5 fnKr,v ,�,� R' �1 TERVICFS <br /> tL'!, 0 Tank i cw,�ktlyn1 <br /> Sire. product di.11ly, <br /> Facility-Address: T'1© �, Ch�R u� 2 Ib dad F_ro <br /> 10 000• <br /> A �1SZ�w 3 L ' S - <br /> Telephone : 2oq 4 67 339 0 °0 `ul'�� Un ekAW <br /> Person Filing (2 000 Alemle- j <br /> Report _ D ct. f �' /S <br /> I hereby certify under penalty of perjury that all inventoryva <br /> rion <br /> /— the above "'tinned facility were within the allowable lims foratithiss for <br /> Quarter. (No in Colum= 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 to an unauthorized (leak) release. (Yes is Colum 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank /, mad amount for all variations that exceeded the <br /> allowable lis<its. <br /> Date Tank 0 Amount <br /> 1. <br /> 2. <br /> 4. <br /> S. <br /> Additioaal datesjamouots shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation vhich. ercecded allowable limits was due to <br /> A leak the incident shall be reported to $ .J . L. N . D. Environmental Health <br /> within 24 hours and an unauchorizcd release report submitted. <br /> T-hc quarterly summary report shall be Kubmitted within 15 days of the end of each <br /> quarter. <br /> Quarter 1 - January <br /> ctcr-q _---^�,ri 1- -- Junc <br /> Quarter I - July --> Scpccmh4:r <br /> kT,arcer 4 - October --) 0q.c.-tuber <br /> Scod co: SAN JOAQUIN LOCAL HEA1,11i Ulti'1'It1C'1' <br /> 1601 E. Hazel♦on , P .O. Box -2009 <br /> Uc;1' 1,0 10/80 tit ockton , CA 95201 466 -6781 <br />