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SAN j- COUNTY PUBLIC TTrAT.TW - -VICES <br /> 4=ONMZNTAL HEALTH DIVISJW <br /> ANNUAL INVENTORY REECONCILT-ITION SMMARY R—EPORT <br /> California UST Regulations, Article 4 , Section 2646 (j) <br /> Facility Name <br /> Address ILV iZ,h city LO <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, SectlonZ646, f r the 12 month period from <br /> 19 to 3.9 <br /> Inventory variations in excess of the allowable limits of Section <br /> 2646, occurred as listed below. <br /> DATE TANK PRODUCT AMOUNT (Gal' <br /> Submit renort, within 13 days following the end of the last month of the <br /> 12-month period covered by the report. Report "Co be submitted to: <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 388 <br /> STOCXTON, CA 95201-0388 <br /> 1 certify under penalty of perjury, that all variations (if any) <br /> exceeding allowable limits ars indicated above (California Health <br /> Safety Code Section 25299) : <br /> M <br /> Facility Tank Operator/Owner Date <br /> EH 23 019 8-1-92 <br />