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SAN JOAQU- COUNTY PUBLIC HEALTH SERV ES <br />ENIV1vc0NMENTAL HEALTH DIVISION <br />ANNUAL INVENTORY RECONCILIATION SUMMARY REP.QRT <br />California UST Regulations, Article 4, Section --2-646(j) <br />Facility Name Ala ill 944 ot 1AND00fK <br />Address /5�, /V• Lam/ 7/oCity :5- <br />All <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 />la,, 1 19 q �' to 31 19 q3 . <br />❑ 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. BOY 2009 <br />STOCKTON, CA 95201 <br />I certify under penalty of per, that all variations (if any) <br />exceeding all able limits are indicated above (California Health & <br />Safety ection 25299): <br />Facility Tank Operator/Owner <br />EH 23 019 3-1-92 <br />Date <br />