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sA.V :'0AQU=N COUNTY PUBLIC H:A1L.7- i SZRVICES <br /> EN",7- ONMZNTA.L HEALTH DIVISION <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4, Section 2646 (j) <br /> Facility Name f1� � i? <br /> address 7, 2wIlf- City <br /> 1zall inventory variations for the above mentioned facility were <br /> within allowable limits of Title 23 California Code of Regulations, <br /> Divisio 3 , Chapter 16, Section 26 6, for the JOJ month period from <br /> i 19 r--J to 19 <br /> Inventory variations in excess of the allowable limits of Section <br /> 2646, occurred as listed below. <br /> DATE Tal`r'cC / PRODUCT AMOUNT (Gallons) <br /> I -a <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 /> STOCRTONf 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, Se I 25'f99) <br /> Facility Tank Operator/Owner Date <br /> EH 23 019 3-1-92 <br />