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SAN JOAQ*_a COUNTY3i• <br />ENVIRONMENTAL HEALTH D IVI O; <br />ANNUAL INVENTORY RECONCILIATION SUKKARY REPORT <br />California UST Regulations, Article 4, Section 2646(j) <br />Facility Name 1c S46 aK-k <br />Address �' ✓te, 0 ,�1 2 City <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 />19 <br />19 1-3 to <br />rN <br />Inventory variations in excess of the allowable limits of Section <br />occurred as listed bel w. <br />DEW TANK PRODUCT AMOUNT (Gallons) <br />Submit report within 15 days following - end of the last month <br />12 -month period covered by the report. Report to be submitted to: <br />SAN TOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRON?tZNTAL HEALTH DIVISION <br />P.O. BOX 2009 <br />STOCXTON, CA 95201 <br />certify under penalty of perjury, <br />exceeding allowable limits are indicated <br />above (California <br />Safety Code, <br />.. * +. <br />I,"/C,Z,6 <br />Date <br />