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SAN JOMUIN COUNTY PUBLIC HEALTH S&VICES <br /> lUvaRONMENTAL HEALTH DIVISICW <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORToiS <br /> California UST Regulations, Article 4, Section 2646(j) <br /> Facility Namel�e, � <br /> Addressd , City U ` <br /> F-1All 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 19 <br /> rInventory variations in excess of the allowable limits of Section <br /> 2646, occurred as lasted below. <br /> DATE TANK # / PRODUCT AMOUNT (Gallons) <br /> q , <br /> ��. <br /> (12 <br /> y At--rLv- <br /> gl- g2 <br /> 5 <br /> c� <br /> R� <br /> 2 <br /> Submit report within 15 da 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 388 <br /> STOCKTON, CA 95201-0388 <br /> I certify under penalty of perjury, that all variations (if any) <br /> exceeding allowable limits are indicated above (California Health & <br /> Saf � <br /> y Code, Sec on 25299) : <br /> '// "" Cj <br /> Facilit ank Operato /Owner Date <br /> EH 23 0 8-1-92 <br />