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INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FO <br />Facility Name: <br />Facility Address: ��3 Alo6 nL <br />Telephone: <br />Person Filing <br />:2 - <br />LLW <br />tank <br />RMII$ Product <br />_ Yoe,) <br />- <br />ly <br />.a1 �� v <br />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. (No in Column 13 of the Inventory Reconciliation Sheet) <br />E] 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 td an unauthorized (leak) release. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank f, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank I 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 shall be reported to S.J .L.II.b. Frnvironax-ntal health <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 cacti <br />quarter. <br />Quarter 1 - January --% March <br />Qjarter 2 - April --> June <br />Quarter 3 - July --> September <br />Quarter 4 - October --> December <br />Send to: SAN JOAQUIN LOCAL 11EAI:Fll ns-rRICT <br />1601 E . daze l.to�tl , 1' .O . 'i" 2009 <br />SLockt:on , CA 95201. 666-6781 <br />UG'r 40 10/86 <br />