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• • RECEIVED <br /> INVENTORY RECONCILIATION JOIN 2 0 1993 <br /> ANNUAL SUMMARY REPORT FORM ENVIR9NMENT4 HEALTH <br /> P�NMIT/�ER�II�€s <br /> Year: 2J Tank L Size Product <br /> Facility Name: <br /> Address: d <br /> lAo <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 not within the allowable <br /> 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 /> FF <br /> Au orized Signature Date Title <br /> Submit report within 15 days following the end of each calendar year. <br /> Send To: <br />