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SAN JOA«N COUNTY PUBLIC HEALTH S ICES <br />EIvvIRONMENTAL HEALTH DIVISIO <br />ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br />California UST Regulations, Article 4, Section 2646(j) <br />Facility Name <br />Address X7,5 ' 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" to /'7-.3i 19 '�?7 . <br />❑Inventory variations in excess of the allowable limits of Section <br />2646, occurred as listed below. <br />DATE TANK ¥ / PRODUCT AMOUNT (Gallons) <br />J <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 />FaciX3 1 TAnk Operator/Owner <br />EH 23 019 8-1-92 <br />Date <br />