COMPLIANCE INFO_1986-1995 - Laserfiche WebLink

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Facility Name;/Luna�� P( 1�1_ Facility Address: A0 V<aA LY Telephone: n i Person Fi4 Report: he?eVy cerl �ynder penalty of perjury variations for the above mentioned facilit allowable limits for this quarter. (N in Inventory Reconciliation Sheet.) that all inventory y were within the column 13 of the Inventory variations exceeded.the allowable limits for this quarter. I hereby certify under penalty of perjury that the source for the variation was not due to authorized (leak) release. (Yes in Column 13 of the Inventory Reconciliation Sheet). List date, tank J, amount for all variations and the reason for exceeding the allowable limits. Date 1 . 1— 2. 3 4 736 5 M Additional dates/amounts shall be continued on a separate sheet of paper and attached. If the source of the variation which exceeded allowable limits was due to a leak, the incident shall be reported to Public Health Services of San Joaquin County Environmental Health Division, within twenty-four (24) hours and an unauthorized release report submitted. 1- The quarterly summary report shall be submitted within fifteen (15) days of the end of each quay _tAr_,Circle _ap1To ate quarter. Send to: Quarter 1 INVENTORY.RECONCILIATION*/�� (f'� uar er Quarter UARTERLY SUMMARY REPORT FORM Facility Name;/Luna�� P( 1�1_ Facility Address: A0 V<aA LY Telephone: n i Person Fi4 Report: he?eVy cerl �ynder penalty of perjury variations for the above mentioned facilit allowable limits for this quarter. (N in Inventory Reconciliation Sheet.) that all inventory y were within the column 13 of the Inventory variations exceeded.the allowable limits for this quarter. I hereby certify under penalty of perjury that the source for the variation was not due to authorized (leak) release. (Yes in Column 13 of the Inventory Reconciliation Sheet). List date, tank J, amount for all variations and the reason for exceeding the allowable limits. Date 1 . 1— 2. 3 4 736 5 M Additional dates/amounts shall be continued on a separate sheet of paper and attached. If the source of the variation which exceeded allowable limits was due to a leak, the incident shall be reported to Public Health Services of San Joaquin County Environmental Health Division, within twenty-four (24) hours and an unauthorized release report submitted. 1- The quarterly summary report shall be submitted within fifteen (15) days of the end of each quay _tAr_,Circle _ap1To ate quarter. Send to: Quarter 1 - Ja_ a r ---------- >March uar er Quarter 2 3 - April ----------- >June - July ------------ >September Quarter 4 - October --------- >December SAN JOAQUIN PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 1991 1601 E. Hazelton, Ave., P.O. Box 2009EN�1,POT NM.N Stockton, CA 95201 PEWITISER'4�L OE LTA{ (209) 468-3420