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SAN J '' UIN COUNTY PUBLIC HEALTH AWVICES <br /> 119VIRONMENTAL HEALTH DIVISI . <br /> ANNUAL INVENTORY RECONCILIATION SUMMARY REPORT <br /> California UST Regulations, Article 4, Secfiion '=A �P( [ <br /> —1p <br /> Facility Name / At! 17 AM <br /> �a <br /> Address City <br /> All inventory variations for the above mentioned facility were <br /> 11��11 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 19 <br /> Inventory variations in excess of the allowable limits of Section <br /> 2646, occurred as listed below. <br /> DATE TANK # / PRODUCT AMOUNT (Gallons) <br /> - 2 <br /> ®a -ryyU 0 <br /> ® Z <br /> ® m <br /> ® ® 2 <br /> 2�® <br /> AL-3 r4tA <br /> 40 <br /> 2 (- <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 /> exceedin to able i 'ts indicated above (California Health & <br /> Safety ode, S tij,n 5 99 <br /> Facility Tank Operator/Owner Date <br /> EH 23 019 8-1-92 <br />