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SAN 1„1QUIN COUNTY PUBLIC HEALTH '^ERVICES <br /> )%. NVIRONMENTAL HEALTH DIVIS%../N <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4, Section 2646 (j) <br /> Facility Name -QL) 7-1-/ <br /> Address /30.- E.5CSLeDy City $C-fCo <br /> All 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 /> 199E to 19 . <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 <br /> I <br /> i I <br /> I I <br /> I <br /> I I <br /> i <br /> I <br /> I I <br /> I i <br /> Submit report within 15 days following the and of the last month of the <br /> 12-month period covered by the report. Report to be submitted to: <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 388 <br /> STOCRTON, 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 /> V// 3� 7- <br /> Facility <br /> Facility Tank Operator/Owner pa�� <br /> EH 23 019 8-1-92 <br />