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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> • ENVIRONMENTAL HEALTH DIVISION <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4 , Section 2646 (j ) <br /> 4 <br /> Facility Name <br /> Address City121 <br /> G,rC- <br /> s <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 1 , Section 2646, for the 12 mo th period from <br /> 19 to 19 <br /> aInventory variations in excess of the allowable limits of Section <br /> 2646, occurred as listed below. <br /> DATE TANK # / 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. BOY 2009 <br /> STOCKTON, CA 95201 <br /> I certify under penalty of perjury, that all variations (if any) <br /> Oceeding allowable limits are indicated above (California Health & <br /> fety Code, Section 25299) : ` <br /> 'acility Tank Operator/Owner Date ` <br /> 23 019 8-1-92 <br />