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SAN JOAQUIN COUNTY PUBLIC HEALTH 9-7RVICES <br /> .rVIRONMENTAL HEALTH DIVIS7V <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4, Section 2646 (j) <br /> Facility Name <br /> Address -11/00 ec.�/ �� S City <br /> aAll inventory variations for the above mentioned facility were <br /> within allowable limits of Title 23 , California Code of Regulations, <br /> Division 3 , Chapter 16, Sectio� 2646for the 12 month period from <br /> W ,/ 19 13 to /,a 4 / 19-q,-?_- <br /> F7Inventory variations in excess of the allowable limits of Section <br /> 2646, occurred as listed below. <br /> DATE f TANK / PRODUCT AMOUNT (Gallons) <br /> I <br /> I <br /> i <br /> I <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 388 <br /> STOCKTON, CA 95201-0388 <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 />