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SAN JOAQ(AW COUNTY PUBLIC HEALTH SERVICES <br /> ENWOMMENTA.L HEALTH DIVISION • <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article4, Section 2646 (j ) <br /> Facility Name n on , <br /> Address \G� {CIJ l.� , �� ? �i`� City G(y�s � o,(� ` LZS 2-0 <br /> All inventory variations for the above mentioned facility were <br /> tt rr within allowable limits of Title 23 , California .Code of Regulations, <br /> D'vision 3 , Chapter 16, Section 646, foil the 12 month period from <br /> YD 19 to QlL)t219 <br /> Inventory variations in excess of the allowable limits of Section <br /> 2646, occurred as listed below. <br /> DATE TANX t / PRODUCT AMOUNT (Gallons) <br /> -2r <br /> i T <br /> F <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 /> exce ing allowable limits are indicated above (California Health & <br /> Safe Code, Se tion 25299) : <br /> Facility Tank Operatorv rer Date <br /> EH 23 019 8-1-92 <br />