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•INVENTORY RECONCILIATION • RECEIVED <br /> JAN 2 01993 <br /> ANNUAL SUMMARY REPORT FORM ENVIRONMENTAL HEALTH <br /> PENMIf/§ERVIeft6 <br /> Year: 'lj Tank # size Product <br /> Facility Name: i <br /> Address: �?WI <br /> �iDr17/ihV <br /> I hereby certify under penalty of perjury that: <br /> All inventory reconciliation data for this year was within the allowable <br /> variations (No entered at bottom of all Inventory Reconciliation Sheets) . <br /> Inventory reconciliation data for this year was hot within the allowable <br /> LAJ variations for the months listed below (Yes entered at bottom of Inventory <br /> Reconciliation Sheets) . <br /> List below the tank(s) and the amount(s) for each month that the allowable variation was <br /> exceeded. To determine the amount exceeded, subtract the calculated Allowable Variation <br /> from the Actual Variation on the monthly Inventory Reconciliation Sheet. <br /> MONTH TANK # AMOUNT TANK # AMOUNT TANK # AMOUNT TANK # AMOUNT <br /> January <br /> February <br /> March <br /> April <br /> May <br /> June <br /> July <br /> August <br /> September <br /> October <br /> November <br /> December <br /> Aut ori ed Signature Date Title <br /> Submit report within 15 days following the end of each calendar year. <br /> Send To: <br />