Laserfiche WebLink
ti � • <br />kVE-NTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Name: <br />MARCH LANL UNION 7F - <br />Facility Address: 2701 W. MARCH LANE <br />'4TT7 <br />Telephone: '10933f1a5Z7,1i' <br />Person Filing <br />Report: <br />a <br />Q I hereby certify under penalty of perjury that all inventory <br />variations for the above mentioned facility were within the <br />allowable limits for this quarter. (No in column 13 of the <br />Inventory Reconciliation Sheet.) <br />Inventory variations exceeded the allowable limitp,for this'--' quarter. I hereby certify under penalty of perjury, tfi t "e <br />source for the variation was not due to auth�drized (;leak) <br />release. (Yes in Column 13 of the Inventory R9.c iTiation ',-- <br />Sheet) . L•3 �,; t -, <br />List date, tank #, amount for all variations and the reason <br />for exceeding the allowable limits. <br />Date Tank Amount Reason <br />il—iS 71 <br />3. 9, :fir ,� (,tJ > C Z -� <br />4. <br />5. <br />Additional dates/amounts shall be continued on 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 to Public <br />Health Services of San Joaquin County.Environmental Health <br />Division, within twenty-four (24) hours and an unauthorized <br />release report submitted. <br />The quarterly summary report shall be submitted within fifteen (15) days of <br />the end of each quarter. Circle appropriate quarter. <br />Quarter 1 - January -_ -------->March <br />Quarter 2 - April ------->June <br />Quarter 3 - July -1 ---------->September <br />Quarter 4 - OctoberJ--------- >December <br />Send to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />1601 E. Hazelton Ave., P.O. Box 2009 <br />Stockton, CA 95201 <br />(209) 468-3420 <br />EH 23 019 (10/89) <br />