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SAN JOA IN COUNTY PUBLIC HEALTH SE `ICES <br /> EWRONMENTAL HEALTH DIVISIOI� <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4, Section 2646 (j) <br /> Facility Name )'/I IM N,I <br /> Address )� ��-f �/- J;,(?�p 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, Section 2646, for the 12 month period from <br /> 1 ) 19 'j I-1 to i<2 ; I 19 <br /> ❑ Inventory variations in excess of the allowable limits of Section <br /> 2646, occurred as listed below. <br /> DATE TANK P / PRODUCT AMOUNT (Gallons) <br /> LI t'. <br /> o.2• 6'1-T <br /> 31, C- L4 „ r , C4. , 1)1) <br /> 1 ) 0. 90 <br /> d� <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) : <br /> -� r U/I , . ,j l)) Y)J- <br /> Facility Tank Operator/Owner Date <br /> EH 23 019 8-1-92 <br />