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SAN JOAN COUNTY PUBLIC HEALTH S*'ICES <br />ENVIRONMENTAL HEALTH DIVISION <br />ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br />California UST Regulations, Article 41 Section 2646(j) <br />Facility Name 67ME71n/y91-',S <br />Address 4/®0 E7- cRElPio r sr City S'7 -0c& N <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 Section 2646, for the 12 m9nth period from <br />�" ^C<' 196 to 1 ilLy?e 2W1492_ - <br />17 Inventory variations in excess of the allowable limits of Section <br />2646, occurred as listed below. <br />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 SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />P.O. BOX 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 />&;2 <br />Facility <br />Facility Tank Operator/Owner Date <br />EH 23 019 8-1-92 <br />