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SAN Ji,QUIN COUNTY PUBLIC HEALTHRVICES <br />IIWVIRONMENTAL HEALTH DIVIS <br />ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br />California UST Regulations, Article 4, Section 2646(j) <br />Facility Name �, , \-\. \MN �T Yom; \Y, -t, )C\ <br />Address 1y `� `� l �, 1_�1��,� C, City <br />[D A11 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 />195 A to _ 19CILA. <br />❑Inventory variations in excess of the allowable limits of Section <br />2646, occurred as listed below. <br />DATE I TANK # / PRODUCT f AMOUNT (Gallons) 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 />Safet-7--C-de, Section 25299) : <br />Facility Tank Operator/Owner Date <br />EH 23 019 8-1-92 <br />