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t SAN JUIN COUNTY PUBLIC HEALTH SVIC <br /> ENVIRONMENTAL HEALTH DIVISION st ��/�j� <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT �7 <br /> California UST Regulations, Article 4, Sectionj@�419A95 <br /> ENVIRONMENTAL HEA <br /> Facility Name ' %�G� l R ��l PERMI LTH <br /> Address ���� ��/T�/C�/`O � 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 6 Section 2646, for the 12 mo th period from <br /> to AIAX 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 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 388 <br /> STOCKTON, CA 95201-0388 <br /> I certify under penalty of perjury, that all variations (if any) <br /> exceeding allowable limits are in icated above (California Health & <br /> Safety Code, ion 29 <br /> Facility Tank Operator weer Date <br /> EH 23 019 8-1-92 <br />