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SAN JANUIN COUNTY PUBLIC HEALTH &VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4, Section 2646 (j ) <br /> Facility Name —/7,"'?n Z- <br /> Address City <br /> F❑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 2646, for the 12 month period from <br /> 19 to <br /> 19. <br /> ElInventory variations in excess of the allowable limits of Section <br /> 2646, occurred as listed below. <br /> DATE TANK PRODUCT AMOUNT (Gallons) <br /> oder t -Z <br /> ,122 <br /> 2 <br /> -s <br /> -7/777 <br /> A <br /> 777 <br /> :7:7EZ/777' <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 388 <br /> STOCKTON, CA 95201-0388 <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 Ope or/Owner <br /> r owner Date <br /> EH 23 019 8-1-92 <br />