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SAN JOAQUIN COUNTY PUBLIC HEALTH SEkVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> C44f2Fnia UST Regulations, Article 4 , Section 2646 (j ) <br /> Facility Name12xc <br /> Address L�L� �E) P �>iitau� / City <br /> 1111 All inventory variations for the above mentioned facility were <br /> �J within allowable limits of Title 23 , California Code of Regulations, <br /> Division 3 , Chapter 16, Section 2646, for the 12 month period from <br /> 191 _ to / - 3/ 19 ;,S <br /> I inventory variations in ex-eOs cf —e allowable liruits of Section <br /> L— 2646, occurred as listed below. <br /> DATE TANK I / 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. BOR 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 Cg e, Section 25299) : <br /> ^r <br /> Facili tf <br /> Tank Operator/Ownetv Date <br /> EH 23 019 8-1-92 <br />