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SAN JOAQ* COUNTY PUBLIC HEALTH SERI&ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4, Section 2646(j) <br /> e-- <br /> Facility Name 3*0 ftl IL <br /> 7 6 <br /> Address Z6 Z3 o Lin L I'V-L city SVS Gk <br /> ElAll 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 2* to yr 19 21 - <br /> EaInventory variations in excess of the allowable limits of Section <br /> -244-6—, occurred as listed below. <br /> J11— As <br /> A e,t-4(-J VIt T1 tZ, /",e. IC T411/al-4a <br /> DATE TANK i0 / PRODUCT AMOUNT (Gallons) <br /> e- <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 ZTOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> IRO AL 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, Section 25299) : <br /> -7 <br /> A5 /59 <br /> Facility Tank Operator/Owner Date <br /> EH 23 019 8-1-92 <br />