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QUARTERLY STATEMENT OF INVENTORY RFCONCILIATION <br /> Lf(if a'.ifIN f: ,HIER <br /> 1 ::04 WI ';T HA 11'J <br /> S./r;S I.INI_Ii AIM 11 <br /> SJ <br /> QUARTER: beginning 7 <br /> ending q <br /> Daily inventory reconciliation data indicates: <br /> �j Inventory variations were within allowable limits. <br /> ❑ Inventory variations exceeded allowable limits. Variations were not due to <br /> an unauthorized release to the environment. Variations are listed below. <br /> Total <br /> Allowable Actual <br /> Variation Variation <br /> Date (Form "4; column L) (Form S-64; coli I) ' <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> (Attach a separate sheet for additional days) <br /> Name of responsible individual (print) <br /> Signature of responsible individual <br /> Telephone Nt=Dber (facility) <br />