Laserfiche WebLink
INV TORY RE ✓CONCILIATION <br /> ~ -T Y SUM.-�.RY REPORT :ORM <br /> 41 <br /> Facility Name: L Tank .4 size 1 <br /> -cz i <br /> Facility Address: <br /> Telephone: <br /> Person Filing <br /> Report: <br /> QI hereby certify under penalty* of perjury that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quay ter. (Na in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> Q ` <br /> Inventory variations exceeded the allowable limits for this <br /> quarter. I hereby certify under penalty of perjury that the <br /> source for the variation was not due <br /> release. to authorized (leak) <br /> (Yes in column 13 of the Inventory Reconciliation <br /> Sheet) . <br /> List date, tank t, amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> Date Tank AmountRe_a <br /> . san <br /> 2 . <br /> ii <br /> 4 : <br /> ------------ <br /> 5. <br /> Additional dates/amounts shall be- continued an a separate <br /> sheet of 'paper and attached. <br /> If the source of the variation which exceeded allowable limits <br /> was due to a leak, the incident shall be reported Public <br /> Health Services of San Joaquin Counc <br /> ty �'�vito pronmental Keubli <br /> Division, within •twenty-four (•24) hours and an unauthorized <br /> release report submitted. <br /> The quarterly summary report shall be submitted within fi;fteen (?5) days of <br /> the end of each quarter. Ci-"cle appropriate guar ter, <br /> Qua--ter 1 - January -------> arch <br /> Quarter 2 - April ______ <br /> >June <br /> Quarter 3 - July ------- <br /> ->Settember <br /> 4 October ` <br /> QLIar mer - <br /> • SAN JOAQUIN COUNTY PUBLIC Sc_RVICES <br /> _. <br /> FW1_RONXMNTAL xZkLTH DIVISION - <br /> X00? E. Hazelton Ave: , P.O.--Box 2009 - ' <br /> Stockton, CA 9!5201 ---- <br /> Z.-H, '_3 019 (, 0/ag) ..:. (209) 468-3420 -- <br />