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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4, Section 2646 (j) <br /> Facility Name: OAK PARK GAS & CONVENIENCE STORE <br /> Address: 3212 N. California St.; Stockton; CA 95204 <br /> All inventory variations for the above mentioned facility were within allowable limits of <br /> Title 23, California Code cif Regulations, Division 3, Chapter 16, Section 2646, for the 12 <br /> month period from: !r' '�i/ / 19 �to % tit , ;"1 19 . <br /> F-1Inventory variations in excess of the allowable limits of Section 2464, occurred as list <br /> below. <br /> Date Tank#/Product Amount (Gallons) <br /> Submit report within 15 days following the end of the last month of the 12- month period <br /> covered by the report. Report to be submit to: <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. Box 2009 <br /> STOCKTON,CA 95201 <br /> 1 certify under penalty of perjury, that all variations (if any) exceeding allowable limits are <br /> indicated above (California Health & Safety Code, Section 25299): <br /> Facility Tank Operator/Owner Date <br />