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SAN JOAQtM-'COUNTY PUBLIC HEALTH SER 0--%-SENVI�fMENTAL HEALTH DIVISION <br />ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br />California UST Regulations, Article 4, Section 2646(j) <br />C-1u0,C9 "IV 'cSaUZ a 11 EG L Uh <br />Facility Name iwi rs F,-, Wit"r," R"'EN" <br />Address STOCKTON (209) 546-085h <br />FEB 04 19 <br />City <br />s <br />PERMIT/SERVICES <br />aAll inventory variations for the above mentioned facility were <br />within allowable limits of Title 23, California Code of ReguL--ations, <br />Division 3, Chapter 16, Section 2646, for the 12 month period from <br />JaY\, 19K2- to 9leC 19 92- . <br />FInventory variations in excess of the allowable limits of Section <br />2646, occurred as listed below. <br />I DATE I TANK # / PRODUCT I AMOUNT (Gallons) I <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 SZRVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />P.O. BOY 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 />Safety Code, Section 25299): <br />C" - <br />1e <br />'�' 4� <br />Facility Tank Operator/Owner Date <br />EH 23 019 8-1-92 <br />