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j $AN JOAQ 1 COUNTY PUBLIC HEALTH S' 'CES <br />ENb�RONMENTAL HEALTH DIVISION <br />ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br />California UST Regulations, Article 4, Section 2646(j) <br />In <br />Facility Name .�i�'jZ� L(� J Z%�L(, �G 0 I r' V3 (2fI �M Z: ( ' <br />Address Li I W,4 nZ C,() () Ep, <br />City S 7 C 7-7 lC <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 />J !'� 19 ( to 19 (� <br />FInventory variations in excess of the allowable limits of Section <br />2646, occurred as listed below. <br />DATE I TANK # / PRODUCT I 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 />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 />Safetv Code, Section 25299): <br />�iw� <br />Facility Tank Operal�r/Owner <br />EH 23 019 8-1-92 <br />Date <br />