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BOARD OF TRUSTEES SANT„)AQUIN LOCAL HEALTH DISTP f <br /> James Culbertson, Pros. SERVING <br /> Patricia tl Vannucci. Secy. 1601 East Hazelton Avenue P. O. Box 2009 San Joaquin CouOf nty <br /> Anthonetls Ven Sproneen , Y <br /> Earl Pimentel Stockton, Cal l f orn la 95201 City of Escalon <br /> Fern eupbee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> City of Tracy <br /> William J. Wade Jopi Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anne Love San Joaquin County <br /> Facility Name <br /> Address <br /> Date of Inspection t ( Inspector KC S <br /> MONITORING ALTERNATIVE 35 <br /> L­/ Annual precision test on tank(s) and piping. <br /> Daily inventory reconciliation with submission of quarterly statement regarding <br /> compliance with allowable variation. <br /> Pipeline leak detectors on pressurized piping. <br /> Daily operational check of suction piping function. <br /> 6,1' Calibrated meters for inputs and withdrawals: <br /> Weights and Measures sticker <br /> L,- 'Certification by qualified repairman <br /> Implementation of this monitoring alternative requires that the following CIRCLED items <br /> be completed by the specified dates. <br /> Precision test(s) must be performed by ([/z(k(p and results submitted to <br /> this office within 30 days of the test. <br /> /2.. Pipeline leak detectors must be installed on pressurized piping by <br /> /3. J Daily inventory reconciliation must be started immediately, with records maintained <br /> at the facility for review. <br /> )X/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 variations that <br /> exceeded allowable.* The first statement is due by zk 7 <br /> Dispenser meter(s) must be calibrated by /i�mbe 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 UGT 1 <br />