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SAN J07 'TIN COUNTY PUBLIC HEALTH S`VICES <br /> 2. ,IIRONMENTAL HEALTH DIVISIOs <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4, Section 2645 (j ) <br /> �� <br /> Facility Name -DLW 9,3 OCT Ia,_ F4 I• i.-r <br /> Address vS (aCity CA 9 4� <br /> QAll 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 <br /> ❑ Inventory variations in excess of the allowable limits of Section <br /> 2646, occurred as listed below. <br /> DATE TANK # / PRODUCT AMOUNT (Gallons) <br /> d <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 C de, Section 25299) : <br /> !O-IZ- 93 <br /> Facili Tank Ooerator/Owrb4rDate <br /> EH 23 19 8-1-92 <br />