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�all� � <br /> INVENTORY RECONCILIATION <br /> -T <br /> H <br /> QUARTERLY SUNNARY REPORT FORK 1p ���MsERHcES <br /> facLLLty Names i hl//ti :' -;t ice/titY Task Stse <br /> Product <br /> facility Addreast 1b'C.S c 1tAlL78R'I y '6` <br /> Telephone : jy y <br /> Person Filing <br /> Report <br /> IBJ L hereby certify under penalty of perjury that all inventory variatioos for <br /> l� the above mentioned facility were vithin the allowable Limits for this <br /> quarter. (No in Colum 13 of the Inventory Reconciliation Sheet) <br /> ❑ Loventery variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to so unauthorized (leak) releaae. (Yes in Colum 13 of the <br /> toveotory Reconciliation Sheec) r r <br /> List date, task /, and •amount for all variations that exceeded the <br /> allowable limics_ <br /> Date Tank / Aasouot <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> Additional daces/aa»uots chill be continued on a separate sheet of <br /> Paper and attached. <br /> If the source of the variation vh.ch e.cocded alluwable limits w s due to <br /> a luk the incsdcn( shall be rcl•or (c.1 to $ <br /> 4lChtn . J I. , H . D . Enviro nmcntal Ilcalth <br /> 24 hours and an unauthor, ccd release report submitted. <br /> ITe Quarterly summary report shall be c•.bmi( ted , ithin 15 days of the end of each <br /> Quarter . <br /> Quarter 1 - January --) March <br /> Q•aartcr 2 - April --> J..n,• <br /> Quarter I - July __) septemhrrV <br /> Quarter 4 - October --) Il.�crmber <br /> Send co_ SAN JOAQUIN LOCAI. HEALTH DISTRICT <br /> 1601 E . I:a r.(• Il .u, , I' . O Roy 211119 <br /> 111;1' 1.0 I0/86 Stockton , CA 95201 466-67bl <br />