Laserfiche WebLink
0 <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />I Z <br />Facility Name:}' <br />Facility Address: 60 (JA71f-Abo <br />Telephone <br />Person F ilin <br />Report <br />Y NOV 2 819P,8 <br />Tank it Size Product <br />- 1- <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 Colua 13 of the Inventory Reconciliation Sheet) <br />QInventory 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 />Date Tank # Amount <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.H.D. Environmental Health <br />within 24 hours and an unauthorized release report submitted. <br />The quarterly sum.:.ary report shall be submitted within IS days of the end of each <br />quarter. <br />Quarter 1 - January --> Hzrch <br />Quarter 2 - April > June <br />Quarter 3 - July September <br />Quarter 4 - October December <br />Send to: SAN JOAQUIN LOCAL a :nirT_H DiS vICT <br />1601 E. F.nzelton, P.O. Box 2009 <br />Stockton, CA 95201 466-6781 <br />UCT 40 10/86 <br />