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-- 1 <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Nana: -'1411 <br /> /UlI14 ZnC T <br /> ank Site. <br /> Product <br /> Fac(lit Address: 6- <br /> Telephone : <br /> Sa/ <br /> r S� E �irS�Telephone : a0y 9y3- )-acPerson Fili�,Report <br /> a)ul�nF <br /> ® 1 hereby certify under pcoalty of perjury that all inventory variations for <br /> the above oeationed facility were within the allowable limits for this <br /> Quarter. (No io column 13 of the Inventory Reconciliation Sheet) <br /> ❑ Iavcntocy variatio: 9 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 unauthori.ted (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) _ <br /> List dace, tank f, aad as.ount for all variatioas t' t ex<.eeded the <br /> allowable Limits- <br /> Date Tank P Amouat <br /> i1. <br /> 2. <br /> 3. <br /> 4. <br /> S. <br /> Additioaal dates/anouots chall be continued on a separate sheet of <br /> paper . rzd �ttachcd_ <br /> It the source of the variation which exceeded allow ble lieoits was due to <br /> A. leak the incident shall be reported to $ J . L . H . D. Envircna.cntal Ilcalth <br /> wiChin 24 hours and an unauthorized release report submitted. <br /> The Quarterly cuo�ry report shall be "bmittcd within IS days of the end of each <br /> Quarter. <br /> Quarter I - January --) H..rch <br /> Quarter 1 - April --) Jun,. <br /> Quarter 7 - July --> Sep• .. <br /> - Quarter 4 - October --) I1<c,-mber <br /> Send tar SnN JOAQUIN LOCAL HEALTI; DISI't( IC'I' <br /> 1601 1'. 1!nZol14u1 , 1' ,0 . Itox Z0(17 <br /> Q(;,]* 40 I0J86 ockton . CA 4)')101 466 - 67b1 <br />