Laserfiche WebLink
INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />W"M <br />Oo0-GRUOTIM010M00/AFsA <br />E] I hereby certify under penalty of perjury that all inventory variations for <br />the above mentioned facility were within the allowable limits for this <br />quarter. (Ko in Column l3 of the Inventory Reconciliation Sheet) <br />JInventory 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 in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank #, and amount for all variations that exceeded the <br />allowable limits. <br />D to Tank F Amount <br />1. <br />2. <br />3. <br />4. <br />5. <br />Additional dates/amounts shall be continued on a separate sheet of <br />paper and attached. <br />If the source of the variation which exceeded allowable limits was due to <br />a leak the incident shal l be reported to S. J . L. H. D. Environmenta 1 [Ica 1 th <br />within 24 hours and an unauthorized release report submitted. <br />The quarterly summary report shall be submitted within 15 days of the end of each <br />quarter. <br />Qu:.rter 1 - January --> March <br />Quarter 2 - April --) June <br />Quarter 3 - July --> Septemhc-r <br />Quarter 4 - October --> Ikcember <br />Send to: SAN JOAQU IN LOCAL HHALI.1i DISTRICT <br />160L E. 11aze l t o�n , P.O. Box 2009 <br />Stockton, CA 05201 466-67b1 <br />L1t;T 40 10/86 <br />