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BOARD OF TRUSTEES SM%4)AQUIN LOCAL HEALTH DISTkw6T SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Patricia E. Vannuccl, Sec'y. 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Anthonette Van Spronsen Clty of Escalon <br /> Earl Pimentel Stockton, California 95201 City of Manteca <br /> Fern BugLee 209/466-6781 City Cit Ripon <br /> ckton <br /> Daniel L. Flores City t <br /> John D. Mast, M.D. City of <br /> fTracy <br /> William J. Wade Jog] Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love /L San Joaquin County <br /> Facility Name <br /> Address <br /> Date of Inspection - 21-Z1 Inspector <br /> MONITORING ALTERNATIVE �5 <br /> ✓ Annual precision test on tank(s) and piping. <br /> ✓ Daily inventory reconciliation with submission of quarterly statement -regarding <br /> compliance with allo],able variation. <br /> Pipeline leak detectors on pressurized piping. <br /> Daily operational check of suction piping function. <br /> ✓ Calibrated meters for inputs and withdrawals: <br /> Weights and Measures sticker <br /> Certification by qualified repairman <br /> Implementation of this monitoring alternative requires that the following CIRCLED items <br /> completed by the specified dates. <br /> Precision tests) must be performed by 7�3/�f1 b and results submitted to <br /> be o <br /> this office within 30 days of the test. <br /> 2. Pipeline leak detectors must be installed on pressurized piping by <br /> 0 Daily inventory reconciliation must be started immediately, with records maintained <br /> at the facility for review. <br /> Cf Document daily check of suction piping function starting immediately. <br /> Submit quarterly statement to this office that allowable variation on inventory <br /> reconciliation has not been exceeded or a list of dates and varia ions that <br /> exceeded allowable.* The first statement is due by T�T/✓d' <br /> Dispenser meter(s) must be calibrated by //T/h with copy of <br /> certification or Weights and Measures sticker number submitted to this office. <br /> If the above compliance dates cannot be met, contact this office prior to the specified <br /> date. <br /> * If allowable daily inventory variation is exceeded, refer to Section 2644(f) for <br /> required actions. <br /> 3-86 <br />