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SAN JOAN 71 =LINTY PUBLIC HEALTH SE '.CES <br /> Ei. _RCN.-.X NTAL HEALTH DIVISION <br /> ANNUAL INVM"ICRY RECONCILIATION SUMMARY REPORT <br /> California UST Re^-11ations, Article 4, Section 2646 (j ) <br /> Facility Name <br /> Address gl/ SJ. ,.1r f :. City /t.lir� l' � nrnr� <br /> F7All inventory variations for the above mentioned facility were <br /> within allowable limits of Title 23 , California Code of Regulations, <br /> Division 3 , Chapter 15, Section 2646, for the 12 month period from <br /> 19 '� toC,t.�,�. 19 'i Y <br /> ❑ Inventory variations Jf <br /> �? excess of the allowable limits of Section <br /> 2646, occurred as listed below. <br /> DATE r-`-K r / PRODUCT AMOUNT (Gallons) <br /> I <br /> i <br /> I � <br /> I I <br /> I I <br /> I <br /> I <br /> I <br /> I <br /> i <br /> I I <br /> I I <br /> Submit report within 15 days following the end of the last month of the <br /> 12-month period covered by tte report. Report to be submitted to: <br /> SALT JOAQ= COUNTY PUBLIC 3EAL73 SERVICES <br /> M=CNM=I'L HEALTH DIVISION <br /> P.O. BOX 388 <br /> STOCXTON, CA 95201 <br /> I certify under penalty o= -e--jury, that all variations (if any) <br /> exceeding allowable limits are indicated above (California Health & <br /> Safety Code Section 25299) : <br /> b'a iity Tank/Operator/Ow:.er Date <br /> ZH 23 019 8-1-92 <br />