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AN <br />ANNUAL <br />California <br />Facility Name 1 <br />JOA,,,IN COUNTY PUBLIC HEALTH Sl_�ICES <br />ENVIRONMENTAL HEALTH DIVISION <br />INVENTORY RECONCILIATION <br />UST Regulations, Article <br />�i <br />SUMMARY REPORT I'+Y."+,1 HEAL Tit <br />4, Section 2646 (j) <br />f: Ij �In-V Ptf2: of <br />9 <br />v <br />Address /%C / 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 to 19 ` <br />tzInventory variations in excess of the allowable limits of Section <br />2646, occurred as listed below. <br />DATE <br />TANK # / PRODUCT <br />AMOUNT (Gallons) <br />�i <br />7K <br />a^ K <br />L� <br />() k <br />�K <br />z.c • <br />k <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 />Facility Tank PL5-e-ratoi?yOwner <br />EH 23 019 8-1-92 <br />Date <br />