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a?&z . JEMCO card <br />lock <br />='Uc lit A.Idress. 1501 <br />Y Charter Way <br />Stockton., CA <br />TC, ephe:,e: 944-9115 <br />Person Filing <br />Repo_ : H. Gordon Fllery <br />-----. —� --- <br />OX I heresy iCa'' � � �` L;nde 'C nz It r . erj a e a ; <br />er -f A 1 �- p � t,r � th�t al l L Gay w.,rx <br />M Lti l.�.t�td:: ;�Ci4 the above : ent-..j..nne-d WRye wp, --h!r. he <br />allowable l;Tr.it r <br />� for tt:d�s qua mr . i°abn ;.n column 1-3 1f the <br />In4entorY Rac �nciliation sheet.) <br />Inventory vajxzra :icz�s a c�e%etaia _'4ha a Io�rahl e s ir>i is for, this <br />ED }� <br />�'uaJ. or . I hereby certid. jl i nda penalty 0- PGrj''1s j �..Lia�... ii.e <br />sour^e _fc- "_he vdria�ion was riot due to at,ifierizad t=eak) <br />release. iia in Column 13 of the 11- " Rewcnci? ic'_ X72 <br />Sheet). <br />�1t' � ate I :t ; '1� `, ct IG�:ia: i:ir l- Vur i at.l -n-- and the rea,= Cn <br />aoz ex eeding the allOwabile 1:.2r,;ts. <br />iffoLn t <br />1. <br />2. <br />3. <br />4. <br />5. <br />1.L$C 4� ti ona dates/amounts sha i l ba Continued or, a Sem arate <br />sheet of F w er and attached. <br />.if the sc u:t iP_, of the Yaa inti on-WJr.iChi exceededo , i n " ., ; �� <br />£l! ! se owa, I�,, Iii a -F; <br />asdsec• ? ethe i T:ci ent rhm ?Health if San Itq-;? <br />-i ne�Rre vrire�oausr.t; ei�v� $ izvt Y �am-iauatiEa <br />c <br />Wi�f:.L »L:C;n__ ^�t;L'� sig; 4,lours ands"iT; jii2ati,-o+r,, Awa:; <br />r 7easo h zi r' <br />"'he quarterly ,_i^ erc- r��oa.e S; all ): C- <br />62 t € 1!5: a-yz C. <br />'9 i1 a:: <br />ha df e'� !s a: '° i p a to quarter. <br />a <br />lr;-Z .,,, .' -f <br />��e�a YiF .i. : <br />`4� ti'_ !1INI . !.+!v 1 to <br />