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SAN JOA JT COUNTY PUBLIC HEALTH SERhICES <br /> ONMENTAL HEALTH DIVISION <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4, Section 2646 (j ) <br /> Facility Name 7% /� M <br /> Address I? 516 N� )'J(4 City S b-1 <br /> All 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 2646r for the 12 month period from <br /> M xc L 19 q 2 to 19 C" . <br /> ❑ Inventory variations in excess of the allowable limits of Section <br /> 2646, occurred as listed below. <br /> DATE TANK n / PRODUCT AMOUNT (Gallons) <br /> -!- <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 /> Facility Tank Operator/Owner Date <br /> EH 23 019 8-1-92 <br />