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INYE NTORY RECONCILIAF IOtl <br /> QUARTERLY $UNNARY REPORT FORM / _` +� <br /> Paeilat, Naa.e: - JA rJ 1 i93 <br /> t <br /> raeilit rank / Sixe <br /> y Address: Product { <br /> L . <br /> Telephone : <br /> Person FILin � <br /> Report r Qlt <br /> Ju 1 hereby cerrif <br /> y �wned fa iliipenalty of perjury that all inventory tion, <br /> Cbe above (No in facilitr were within the allowable limits 9uartcr. vada for <br /> (Ho to Column 1)of the Love aCoc R for Ghia <br /> y ,conciliation Sheet) <br /> ❑ levencory variation■ exceeded the .11("Abl <br /> e Limits for this <br /> beceby certify wader <br /> Penalty of perjury that the source for auacter. j <br /> wa■ not due to as uoauthorired (leak) release. the variation <br /> Iaveatory Reconciliation Sheet) <br /> (re' in Colu-n 11 of the <br /> Listt <br /> dace, tank /, and aa•ount <br /> allllowable for all variation■ Chat eKceeded <br /> limits_ <br /> the <br /> Date rank / <br /> Amount <br /> I. <br /> J. —� <br /> AddiCioaal daces/amouacs chill be continued oa a separate .h <br /> paper and atcachad. <br /> eet of <br /> It Chc 20UCCC of Chc variation ..h ich c<cccdcd alluw blc limits viz <br /> • I<ak <br /> (tic <br /> lnCldCn( shall b <br /> wt(htn jq c r1IX,il d (n due Co <br /> Irours and an un,"thori •' . J . L . l1 O _ F.nvt con�+cnC, l Ilc, l ( h <br /> ccd rcicasc report xubmi(ted. <br /> aJ(.rGuarCerly suu.vey ""C( shall tic <br /> eubmi( (rd within 15 days of (tic end of each <br /> Q11 A <br /> Ja niu r4) -) ry.,r Cl, <br /> Q".' <br /> r tr <br /> (r.a rtcr I - July <br /> (�ur(or C �`'rr(cmhrr <br /> Send Co: <br /> AN JOAQIIIn UU:Al. HEAL'Il UIS'I'I< IC'f <br /> Hazel ( t.n . 1, . 0 . hox 2009 <br /> 40 10/F{6 <br /> Stockton , CA 4)5201 466 -67bl <br />