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.ti SAN SOAQu& cou-NTY PUBLIC HEALTH SERNj*ES <br /> ENV DNMENTAL HEALTH DIVISION <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4, Section 2646 (j ) <br /> Facility Name <br /> 7 IV \ ejC� L �y1c\Qr\ Gxr` \ <br /> Address `�y Q3 F,, )y$C�.�J Z,�, Cityc �p1.� <br /> All inventory variations for the above mentioned facility were <br /> ll�llL��� within allowable limits of Title 23 , California Code of Regu{.3tions, <br /> Division 3 , Chapter 16, Sectio 2646, for the 12 month period from <br /> SAVE 1991A, to 3l 192i�. <br /> ❑ Inventory variations in excess of the allowable limits of Section <br /> 2646, occurred as listed below. <br /> DATE TANK t / PRODUCT AMOUNT (Gallons) <br /> Submit report within 15 days--following the end of the last month of the <br /> 12-month period covered by thy:report• Report to be submitted to: <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL RRAT•TH DIVISION <br /> P.O. BOY 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, <br /> \section 25299) : <br /> Facility Tank Operator/Owner Date <br /> EH 23 019 8-1-92 <br />