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yxi <br /> Eg <br /> AN Ja46IN COUNTY PUBLIC HEALTS s <br /> cEs <br /> 199�� <br /> J A iV 0NVIRONN14ENTAL HFALTH DZVTSION <br /> � <br /> ANNUAL INVENTORY RECONCILIATION SUMMARX REPORT <br /> California UST Regulations, Article 4, Section 2.646(j) <br /> ENVIRONMEN IAL HEALTH, <br /> PERMIT/SERVICES <br /> Facility Name :� <br /> Address l Al City <br /> EDAl? 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 tram <br /> 19 < to �, ✓ 3.9 , <br /> Inventory variations in excess of the allowable limits of Section <br /> 2646, occurred as listed below. <br /> DATE TANK J / pRODUCT AMOUNT (Gallons) <br /> Submit report within 15 days fol.10ving the end of the last month of the <br /> 12-month period covered by the report. Report to be submitted to: <br /> SAN JOAQUIN COOATY PUBLIC HEALTH SERPICSS <br /> MiVZRaWMITAL liEALTz DIVIsZoR <br /> P.O. Box 2009 <br /> STOCKTON, CA 9$201 <br /> I certify under penalty of perjury, that all variations (if any) <br /> excee g allowable limits are indicated above (California Health & <br /> sate y C e, 5e 25299) <br /> ac'lracaity Tank oper/Owner Date <br /> 23 019 8-1-92 <br /> TOTAL P.02 <br />