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SAN JOAC"IN COUNTY--PFUBLIC HEALTH SEF"'ICES <br />Ei`,:RONMENTAL HEALTH DIVISION- <br />ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br />California UST Regulations, Article 4, Section 2646(j) <br />Facility Name TERE41 -1 2V Cif I NG 111C , <br />Address 9 00 1�2.y 1-cTo(R Rb . City I -OD 1 C R <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 />l^ i <br />19,15 to + VI -so 1995 <br />* AL -L UQI eedGROUNZ-T14U(,LS RCHOV" , <br />❑Inventory variations in excess of the allowable limits of Section <br />2646, occurred as listed below. <br />DATE I TANK t / PRODUCT I AMOUNT (Gallons) <br />Submit report within 15 days following the end of the last month of the <br />12-manth 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 />exceeding allowable limits are indicated above (California Health & <br />Safety,Code, Section 25299): <br />L ;k --;L9 -9 5 <br />Faci 't Tank Operator/Owner Date <br />EH 23 019 8-1-92 <br />