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OR <br /> AN JOA LN COUNTY PUBLIC HEALTH SE ICES <br /> n S <br /> EAVIRONMENTAL HEALTH DIVISION" <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY, R,EPORT <br /> California UST Regulations, Article 4, Section 2646(J)HEA) 7'l1 <br /> G�jaF <br /> Facility Name ('G fl <br /> Address L-S-C{ACCIA11 PIA� ( _ City <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 /> - �� 19 C-' 3 to <br /> aInventory variations in excess of the allowable limits of Section <br /> 2646, occurred as listed below. <br /> DATE TANK # / PRODUCT AMOUNT (Gallons) <br /> Submit report within 15 days following the end 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 2009 <br /> STOCKTON, CA 95201 <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 /> _r <br /> Facility Tank Operator/Owner Date <br /> EH 23 019 8-1-92 <br />