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SAN TCAQjM COUNTY PUBLIC HEALTH SC:-:S <br /> L HEALTH DIVISION <br /> ANNUAL INVTORY RECONCILIATION SUMMARY PtYP 4ENTAL HEALTH <br /> �i <br /> California UST Regulations, Article 4, Section � ' RVICE <br /> 95 JAN 17 PM 1: 49 <br /> Facility Name _ V e <br /> Address (�� `�. >_ 0&\ 0 J-Ae— City L e <br /> C - <br /> All inventory variations for the above mentioned facility were <br /> within allowable limits of Title 23 , California Code of Regu{.-,Ltions, <br /> Division 3 , Chapter 16, Section 646, for the 12 mo th period from <br /> 19CA% to G 19 . <br /> Inventory variations in excess of the allowable limits of Section <br /> 2646, occurred as listed below. <br /> DATE TANK t / PRODUCT AMOUNT (Gallons) <br /> I <br /> Submit report within 15 days,.following the end of the last month of the <br /> 12-month period covered by th�-,',report. Report to be submitted to: <br /> SAN JOAQUIN COUNTY PUBLIC BY.ALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOY 2009 <br /> STOCYTON, 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 operator/owner Date <br /> EH 23 019 8-1-92 <br />