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d SAN JOAQ N COUNTY PUBLIC HEALTH SE' :CES r <br /> EN�RONMENT.AL HEALTH DIVISION <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPO ,jR'i`�rAL HEALrh <br /> California UST Regulations, Article 4, section 2tfit(j)FEF(y►CE <br /> _ % JAN 2 ! PM I. 58 <br /> Facility Name Qgp��u bw c/R4 _;;c <br /> Address S6Z Aelnonf v City Simon <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 Aemm&r 3/ 19 yJ <br /> ❑ Inventory variations in excess of the allowable limits of Section <br /> 2646, occurred as listed below. <br /> DATE TANK 0 / 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 TOAQUIN 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 /> Facility Tank Operator/Owner Date <br /> EH 23 019 3-1-92 <br />