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SAN JOAQUIN COUNTY PUBLIC HEALTH SrRVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California OST Regulations, Article 4 , Section 2646 (j ) <br /> Facility Name &0 RoAt, L_ <br /> Address 3 (ed 6 • CA6W.L 'r' - City S�O nj <br /> aAll inventory variations for the above mentioned facility were <br /> within allowable limits of Title 23 , California Code of Regulations, <br /> Division 3 , Chapter 16, Section 2646, for the 12 month period from <br /> :2NIAAPG ( 19 q7 to 7yP.o �n 3 19 (1' -7 . <br /> Inventory variations in excess of the allowable limits of Section <br /> 2646 , occurred as listed below. <br /> DATE I TANK . / PRODUCT I AMOUNT (Gallons) <br /> I I <br /> I <br /> I <br /> I I <br /> I <br /> I I <br /> I I I <br /> I <br /> I <br /> I <br /> I <br /> I I <br /> I I <br /> I I <br /> I I <br /> I <br /> I <br /> Submit report within 15 days fallowing the end of the last month of the <br /> 12-month period covered by the report. Report to be submitted to: <br /> SAN T0AQUTN COUNTY PUBLIC BEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 388 <br /> STOCKTON, CA 95201-0388 <br /> I certify under penalty of perjury, that all variations (if any) <br /> exceeding allowable limits are indicated above (California Health & <br /> Safety Code, Section 25299) : <br /> 3 - 3l - 9q <br /> Facility 97Ank Operator/Owner Date <br /> EH 23 019 8-1-92 <br />