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SAN JOAN N COUNTY PUBLIC HEALTH SE ICES <br /> E14'1�'LRONMENTAL HEALTH DIVISION— <br /> ANNUAL <br /> IVISION ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT �q <br /> California UST Regulations, Article 4, Section 2646 (j) T <� <br /> c� fry <br /> Facility Name <br /> Address �7)�0 r tl�Lnbo City L i <br /> 7 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 2646for the 12 month period from <br /> 1U�tUc_y 19 9J to �('osk ,�;r 19 <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) : <br /> 1Faci314- <br /> Facility <br /> lity IZ44 <br /> Operator/Owner Date <br /> EH 23 019 8-1-92 <br />