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L1`-U1-1'�'�1 Ui �or'I'I rrLu _'i i:.bJUl <br /> SAN JOAr I COUNTY PUBLIC HEXLTH SE' CES <br /> E,Nk . -RONMj.NTAL HEALTH DIVISION <br /> ANNUAL INVENTORY RECONCILIATION SUTAYARY REPORT <br /> California UST Regulations, Article 4, Section 2646(j ) <br /> Facility Name <br /> Address ��� _P.t IZi21 Ute- �-C� City L6d� <br /> All inventory variations for the above mentioned facility were <br /> within allowable limits of Title 23 , California Code of Regulations, <br /> ivision 3 , Chapter 16, Sectiq 2646, for the 12 month period From <br /> r 19 <Ito -Qcn'W I 19 <br /> Inventory variations in excess of the allowable limits of Saction <br /> 2645, 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 JOAQCIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL. 11 ALTH 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 3-1-92 <br />