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U--UL-i"4 cU =i�H'I rrUl'I IU 17�:.�.]d��c F'.U1 <br /> SAN TOA COUNTY PUBLIC HEALTH SEROMS <br /> g�i ONM7-NTkL HEALTH DIVISION <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT "ITf! <br /> California UST Regulations, Article 4, Section 2646 (j)- --I LA- <br /> j4. ;V2E <br /> Facility Name �{Qa ' FEB 14 PN 2: 21 <br /> Address y N 1--9OL-a, S1 . Cit p <br /> aAll inventory variations for the above mentioned facility were <br /> within allowable limits of Title 23 , California Code of Regulations, <br /> Division 3 , Chapter 16, Secti n 2646, for the 12 month period from <br /> 19 to p 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 the report. Report to be submitted to: <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 2009 <br /> STOCETON, 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 /> Facility Tank operator/Owner Date <br /> EH 23 019 8-1-92 <br />