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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> rsei1LCT NameT— <br /> rn� , Luk / Site <br /> Product <br /> [aeLllty Addreaai ?cam U� <br /> Telephone : _ <br /> Person Filing <br /> Report , � �� <br /> c � <br /> L hereby certify under penalty of perjury that all inventory variation■ for <br /> the above %cnCiooed facility were within the allowable limits for this <br /> Quarter. (Ho in Col"® 13of the Invcotory Reconciliation Sheet) <br /> ❑ Inventory variation• exceeded the allowable limits for this quarter. t <br /> hereby certify under peaslty of per <br /> was not due Co an najury that the source for the variation <br /> Inventory Recoociliartion iced ( le.k) releaser 1. (Yes in Column 13 of the <br /> on ShccC) <br /> List date, taok /, and a nC for all variations Chat exceeded the <br /> allowable li"ita- <br /> Datc Teak / <br /> Amount <br /> I. <br /> 1. <br /> 4 <br /> S. <br /> 5� <br /> �dsCzooal daces/amovncn shall b <br /> c conC,aucd on a .epa ra cc ah<cC of <br /> PaPcr and aCt ached , <br /> if (h-c source 't Chc var,a( „m ..h,<h r .rrrdcA alluwhlc l (m, (' wz Aur Co <br /> • Ic.k Chc "C (dcn( shall br rrporcc,l In 'i <br /> within J I. H D mc Env, ronncal IICa I ( I, <br /> 24 boort ,nA an un.n,( hnrr (cd sr rc Por( +-ubm(cCcd . <br /> the Quarccrly avmury rc Por( .hall br .0 bm, ((,-d w, (h,n I ) days of Chc cnd of o.1cl, <br /> qu.r ( rr <br /> QwarCcr I - J�nu.rY __) h.,rCh <br /> Qvar(cr ] - July _ <br /> Q•.a rtcr 4 - Oc(obcr --) Ikccmhcr <br /> S<nd co; <br /> SAN JOAQUIN Un:AI. HEALTH 01SfHIC'I <br /> 1601 h: I!,�i(• Il +ul , I' 0 Hos 1111 l') <br /> 40 10/ K6 S( ockton , CA 95201 1,66 -6161 <br /> IJ1:1 <br /> II 6r <br /> L • <br />