Laserfiche WebLink
A M a <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Nam,: ';)c !2 <br />Fac icy Address:vv <br />Telephone: c s �S <br />Per s o n F(;-1 <br />Re ort` <br />I hereby certify under penalty of perjury that alI inventor variations <br />the above oentioned facility were within the allowable limifor <br />quarter. (Ho in Column l3 of ts for this <br />the Lnvencory Reconciliation Sheet) <br />Io ntory variations exceeded the allowable Limits for this quarter. y <br />ereby certify under penalty of perjury that the s <br />was not due ource for the variation <br />to as unauthorized (leak) release. (Yes in Colin 13 of the <br />Iaventory Reconciliation Sheet) _ <br />List date, tank f, and zmount for all variations that exceeded the <br />allowable liotits. <br />Date Tank I <br />Amount <br />2 _ <br />--- <br />3. <br />4. <br />Additional dates/amounts &hall be conti <br />Paper and attached. nued o❑ s separate sheet of <br />If the source of the variation which exceeded allowable limi <br />a leak the incident shall be reported to <br />wiJ.L <br />thin 24 hours and an unauthor- rrlcasc t ts was dui Co <br />J.L.H.D. <br />D, Envidonah <br />ncal lfealt <br />I-hc quarterly summary report ;hall b, submicCccf within IS Aay; ut the end of c•,1 <br />ch <br />Quar-Cer t January --> "arch <br />Q+lartcr 2 - April __> J11(le <br />C�h+-zFc--J-` July --> :;ef)ccmbrr <br />Q•-r'gICrr 4 - October --> (k--cembcr <br />I nA to: <br />UCT 40 10/86 <br />SAN .JOAQUIN LOCAL. HEAL'I'Ii DISTRI(,I, <br />1601 F. liazelton, I'.0. Box ?009 <br />Stockton, CA 95201 466-6781 <br />