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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />• ENVIRONMENTAL HEALTH DIVISION <br />ANNUAL INVENTORY RECONCILIATION CaY REPORT <br />California UST ,Re �,{}ons, Article 4, Section 2646(j) <br />b `h CIE <br />Facility Name ¢ <br />s3—�1 <br />Address/:� ��9�'✓ S! •• City <br />X All inventory variations for the above mentioned facility were <br />I_r/I within allowable limits of Title 23, California Code of Regulations, <br />Division 3, Chapter 16, Section 2646, for the 12 month period from <br />✓z --e 1996 to L-d�� 19 '--/ Z. <br />F7Inventory variations in excess of the allowable limits of section <br />2646, occurred as listed below. <br />DATE I TANK � / PRODUCT I 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 368 <br />STOCXTON, 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, Sectio 25299): <br />.,.:ility Tank Onerator/Owner Date <br />EH 23 019 8-1-92 <br />