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SAN JOAQ 'I COUNTY PUBLIC R_AT-Ta SERI--CRs <br /> ENWONMENTAL HEALTH DIVISION 0 <br /> ANNUAL INVE%aORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4, Section 264,6 (jF�,lTil <br /> Facility Name lrnyj 1� _\ +r���� ( c\4-k\2�zt-D17 e,i I• cam_ <br /> Address _ $2-0; City Z_�C- <br /> I SCI All inventory variations for the above mentioned facility were <br /> I / within allowable limits of Title 23 , California Code of Regu{.ations, <br /> Division 3, Chapter 16, Section 2646, for the 12 month period from <br /> BSc-\\ \ 19ca to 19 . <br /> Inventory 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 th4 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) : j <br /> Facility Tank Operator/Owner Date <br /> EH 23 019 8-1-92 <br />