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H-Ilul i i u i :d� �-�o� H. ui <br />SAN JOAQW COUNTY PUBLIC HEALTH SE9ftCZS. <br />MMh0NMF.NTAL HEALTH DIVISION <br />ANNUAL INVENTORY RECONCILIATION SMqMARY REPORT <br />California UST Regulations, Article 4, Section 2646(j) <br />Facility Name <br />Address �D Q L city L -O .� <br />IZIAll inventory variations for the above mentioned facility were <br />within allowable limits of Title 23, California Code of Regulations, <br />Division 3, Chapter 16, Sect'on 2646, for the 12 Month period from <br />19 to 19 <br />El <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 X EAL TH SERVICES <br />a+ r ,.• ► DIVISION <br />P.O. <br />STOCXTONJ 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 />Fac;lity'Tank Operator/Owner <br />EH 23 019 8-1-92 <br />Date <br />