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SAN JftUIN COUNTY PUBLICHEALTH <br /> 'IRONMENTAL HEALTH ISlItRVICES <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4, Section 2646 (j) <br /> Facility Name <br /> Address U-,L V%'Q& city CA <br /> All inventory variations for the above mentioned facility were <br /> If within allowable limits of Title 23 , California Code of Regulations, <br /> Division 3 , Chapt19 l to <br /> 16, Secti 2 l646, for the 12 month period from <br /> 0act 3 1 19 <br /> Inventory variations in excess of the allowable limits of Section <br /> 2646, occurred as listed below. <br /> DATE TANK PRODUCT AMOUNT (Gallons) <br /> Submit report within 13 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 aOAQUIN 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 are indicated above (California Health <br /> Safety Code, ection 25299) : <br /> J q 7 <br /> Facility Tank Operator/owner Date <br /> EH 23 019 8-1-92 <br />