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BOARD TRUSTEESSAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, <br /> pros.re <br /> Patricia E. Vannucci, Secy. City of Lodi <br /> Anthonette Van SPronsen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Pimentel Stockton, California City ofEscalon <br /> Fern Bugbee City of Manteca <br /> Daniel L. Flores 209/488-8781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anna Love San Joaquin County <br /> San Joaquin County <br /> Facility Name <br /> Address <br /> Date of Inspection Inspector <br /> MONITORING ALTERNATIVE #5 <br /> —J��Annual precision test on tank(s) and piping. <br /> Daily inventory reconciliation with submission of quarterly statement regarding <br /> compliance with allowable variation. <br /> �ipeline leak detectors on pressurized piping. <br /> Daily operational check of suction piping function. <br /> alibrated meters for inputs and withdrawals: <br /> /i47eights and Measures sticker <br /> Certification by qualified repairman <br /> Implementation of this monitoring alternative requires that the following CIRCLED items <br /> be completed by the specified dates. <br /> 1 . Precision test(s) must be performed by and results submitted to <br /> this office within 30 days of the test. <br /> 'Pipeline leak detectors must be installed on pressurized piping by <br /> Daily inventory reconciliation must be started immediately, with records maintained <br /> at the facility for review. <br /> 4. Document daily check of suction piping function starting immediately. <br /> U 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 �;, —3/_ Y�C, <br /> 6. Dispenser meter(s) must be calibrated by with copy of <br /> certification or Weights and Measures stic er 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 />