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SAN JOA* COUNTY PUBLIC HEALTH SE1ftCES <br /> ENVIRONMENTAL HEALTH DIVISION '.:, <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4, Section 2646(j ) <br /> C '<� <br /> Facility Name �C'✓ ���.�- Fb <br /> / <br /> Address / ,� / i'Z/ � City <br /> c <br /> 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 2646, for the 12 mo th period from <br /> —/ 19 :2z to <br /> F 7 <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 /> 1 certify under penalty of perjury, that all variations (if any) <br /> exceeding allowable limits are indicated above (California Health & <br /> Safety Code, Se tion 25299) •. <br /> �z <br /> At <br /> Faci.li.t ank Operator/Owner Date <br /> EH 23 019 8-1-92 <br />