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SAN JOA :N COUNTY PUBLIC HEALTH SF -ICES <br /> EN IRONMENTAL HEALTH DIVISION" <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST <br /> Regulations, Article 4, Section 2646 (j) <br /> _ / / /UC��/x/ 211c, <br /> Facility <br /> Name ((/lQ//(( / / <br /> Address 3�� �/Q/�0/1T Sr City �Cf(1�2 <br /> F] All inventory variations for the above mentioned facility were <br /> within allowable limits of Title 23 , California Code of Regulations, <br /> Di on 3 , Chapter 16, Section 2646, for the 12 month period from <br /> 19 77 to l0�,C 'Q,,4 3/ 199. <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 /> 3 C V 6, (4k ix <br /> STOCKTON, CA 9324 <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 a Operator/Owner Date <br /> EH 23 019 8-1-92 <br />