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(@SAN JOAQ i COUNTY PUBLIC HEALTH SEF CES <br /> EN,*fRONMENTAL HEALTH DIVISION "O' � ��� <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPOR <br /> California UST Regulations, Article 4, Section 2646 (TE B 05 1993 <br /> 6 pdj � � ENVIRONMENTAL HEALTH <br /> FacilityName /L//�/ �A/ .[� �/ PERMIT/SERVICES <br /> ,f <br /> Address �IOC� /�(EflON City O (J rJ2r,A <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, Section 2646, for the 12 month period from <br /> q 19 2 to T <br /> ❑ Inventory 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. 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 Code, Section 25299) : l / <br /> yl�3 <br /> Facility Tank Op for/Owner Date <br /> EH 23 019 5-1-92 <br />