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i <br /> INVENTORY RECONCILIATION <br /> "ARTERir SNMMART REPORT FORM JAN 111989 <br /> ENV";ONNIENTAL HEALTH <br /> raciUty Nafn: t PERMIT/SERVI E <br /> spa. Product <br /> rscility Addr...t <br /> -F.Prr.P 1.r/�✓ <br /> Telephone ; -,PI0 <br /> Person Piling <br /> Report �o,y <br /> ❑ I hereby certify .oder Penalty of perjury that all inventory variations for <br /> the above meaticeed facility were within the allwable limits for this <br /> quarter. (No is Coluum 13 of the laveatory Reconciliation Sheet) <br /> ❑ Inventory variations exceeded the allwablc limits for this quarter. i <br /> hereby certify under penalty of perjury that the source for the variation <br /> vas not due to as unauthorized (leak) «lease. (Yes in Colum a13 of the <br /> Inventory Reconciliation Sheet) <br /> t r . <br /> List date. tack /. and amount for all variations chat exceeded the <br /> a Movable limits. <br /> Date Tack I Mount <br /> I. <br /> 2. <br /> 7 <br /> 4. <br /> AddiCioeal dates/amounts shall be continued on a acparate sheet of <br /> Paper and at[ached. <br /> if the source of the variarion ..h.ch racceded alluuable limits w s due to <br /> • Icak the incident shall be rcpurted rn <br /> within 4 h S .J L . H D . EnvsronaenCal Ilcal[h <br /> 2 ours and an unnuthor . erA r-elcasr report subait[ed. <br /> The 7uarcerly auasary report shall be a•,bm.tted within 15 days of the end of each JI <br /> QVa((e( <br /> Quarter 1 - Janu.ry <br /> Qaartcr 2 - April <br /> Quarter ) - July _-> is ptcwha( 11 <br /> Quarter 4 - October --) Ikceftber <br /> Send co: SAN JOAQUIN LOCA1. IItALTI; DISTRICT <br /> 1601 E . I!art• 11 ..n , 1' .0 Ikas Z(111 ) i <br /> ('(;1 40 10/N6 Stockton . (.A 1/5201 466-6761 <br />