Laserfiche WebLink
j � a <br /> �0 <br /> �� <br /> JORY RECONCILIATION <br /> ti,... .LY SUMMARY REPORT FORM <br /> FaeiLity Name: Tank # size Product <br /> 5 , T-re 77 <br /> Facility Address; le7 sr- <br /> � <br /> Telephone : o - app <br /> Person Filing <br /> Report <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 /> 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 to an unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank 1, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank £ 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 Bourse of the variation which exceeded al-lovable 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 summary report shall be submitted within 15 days of the end of cacti <br /> quarter. <br /> Quarter I - January --> March <br /> Qsartcr 2 - April --> ,lune <br /> Quarter ] - July --> Scptemher <br /> Q,artcr 4 - October --> 0�crmber <br /> Send co: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . Haze l t t1n , 1) .0 . Ilo�x 1OO`} <br /> St- ockCori , CA 95201 460 -6781 <br /> ll ;T 140 10/ 90 <br />