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SAN JOAQ* COUNTY PUBLIC HEALTH SEPIWES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4 , Section 2646 (1 ) <br /> J <br /> Facility Name l\, Z-111- \• <br /> Address City <br /> ❑ All inventory variations for the above mentioned facility were <br /> within allowable limits of Title 23 , California Code of Regulations, <br /> vcision 3 , Chapter 16, Sect' 2646, for the 12 month period from <br /> 1i <br /> 19 y to _ — 19�. <br /> 1-13 <br /> ® Inventory variations in excess of the allowable limits of Section <br /> 2646 , occurred as listed below. <br /> DATE TANK # / PRODUCT AMOUNT (Gallons) <br /> f <br /> A4 JA. <br /> y 7 <br /> 9y ,►c + 5 <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. BOR 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 /> S ty Code, Section 25299) : <br /> 9 �? <br /> Facility Tank Operator/Owner Dat <br /> EH 23 019 8-1-92 <br />