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AN JOAQ' T COUNTY PUBLIC HEALTH SEP, <br /> ER CES SOUTH COUNTY FOOD 8,�LCO. <br /> EN- YMONMENTAL HEALTH DIVISION MD SANDS CORPORATION <br /> X POST OFFICE BOX 516 <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT ESCALON,CA 95320 <br /> California UST Regulations, Article 4; Section 2646 (j) <br /> Facility Name 5•�, «ecrvTy warn £ /u1'1 l .;, <br /> Address 1,30s City 1 S�iILG�V� <br /> F7F77- within <br /> k l All inventory variations for the above mentioned facility were <br /> l ' 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 0 '7 to <br /> F-1Inventory 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 Z5299) : <br /> Facility Tank Operator/Owner Date <br /> EH 23 019 B-1-92 <br />