Laserfiche WebLink
1W 6 <br />01 <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM L <br />11 1991 <br />ENVIRONMENTAL HEALTH <br />Facility Name: PERMIT/SERVICES <br />_ lank t <br />f Size Product <br />Fac. ity Addressr <br />: —Fl - <br />Telephone:: 20 _ - <br />Person Fi ing <br />Report <br />® I hereby certify under penalty of <br />t all iion <br />the above mentioned facility were within ythe aallowableentory lim tsvarforatithiss for <br />quarter. (Ko in Column 13of the Inventory Reconciliation Sheet) <br />QInventory variations exceeded the allowable limits for this quarter. I <br />hereby certify under penalty of perjury <br />was not due that the source for the Variationto 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 <br />Amount <br />1. V-1 <br />2- % -i/ —% <br />--- <br />3 . INC —C// % <br />— R'2- <br />4. z%-j--�' ' �0 / <br />—/0 r <br />5. <br />Additional dates/amouats shall be cont'- <br />Paper and attached. nued oo a separate sheet of <br />If the source of the variat- <br />ion which exceeded allowable limits was due to <br />A leak the incident shall be reported to <br />Within 24 hours and an unauthorized release rcporlt subm[[edontal Health <br />The quarterly summary report shall be ,ubmitted Within <br />q.varCer. IS days of the end Of c,,i <br />ch <br />Quartet I - <br />garter 2 ' - <br />January <br />April <br />--> Narch <br />--> Junc <br />Quarter 3 - <br />July <br />--J :;eptember <br />Quarter 4 - <br />October <br />--> December <br />Sena co: SAN .JOAQUIN LOCAL. HEALTH DISTRICT <br />1601 F. Hazelton, P.O. Box 2009 <br />IICT 40 I0/$6 Stockton, CA 95201 466-6781 <br />