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INVENTORY RECONCILIATION <br /> T4 <br /> QUARTERLY SUMMARY REPORT FORM � \�>� ✓ \��,�� <br /> Facility Nagel i — _ AVENULE <br /> Task I Size <br /> ProductVRON F <br /> PlIONL.. 8'facilicy Addresm '-'717 3 <br /> ANT <br /> Telephone : <br /> 25436 <br /> Person Filing <br /> Report <br /> I hereby certify under penalty of perjury that all inventory variations for <br /> j" the above --minced facility -were within the allowable Limits for thin <br /> quarter. (He is Colum 13 of the Inventory Reconciliation Sheet) <br /> 0 inventory vsriatioas exceeded the allowable limits for this Quarter. I <br /> hereby certify under penalty of perjucy that the source for the variation <br /> was not due to as unauthorized (leak) reLeise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) t <br /> List dater tack f. and amount for all variations that exceeded the I <br /> allowable limits. <br /> Date Tack 1 /Imus[ <br /> 2. <br /> 1. <br /> 4. <br /> AddiCicesF da:ea!a�eueca shalt be continued on a separate •heel of <br /> Paper and attached. <br /> It the source of the variation which cncecded allocable limits was due to <br /> s leak the incident shill be reported to S .J . I. . H . D . Environmental Ilcalth <br /> wtthtn 24 hours and an unauthor ,zcd release report submitted. <br /> Ilse avarterly ■ua.aary report shall be s.sbmitted within IS days of the end of each <br /> Qt/ar(rf , <br /> Qua cr I - Janusry __) Narth <br /> Q.ascer 7 - April --> June <br /> Quarter ) - July --) septemher <br /> Quarte 4 - October --) D ccmher <br /> Send cc: SAN JOAQUIN I.0CAl. IIEAI.I'li DISTRICT <br /> 1601 E . I!a•zelitm , P .O . Ilex 111117 <br /> Stockton . CA 75101 466-6761 <br /> 0I:1 40 10/ H6 <br />