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BOARD OF TRUSTEES <br />James Culbedson. Pres. <br />Palriola E. Vannuccl, Secy. <br />Anthonotte Van Spronsen <br />Ead Plmentel <br />Fem Bugbee <br />Daniel L. Flores <br />John D. Most. M.D. <br />William J. Wade <br />Mary Anna Love <br />Facility Name <br />Address <br />SAt.,JAQUIN LOCAL HEALTH DIST[ ^ T <br />1601 East Hazelton Avenue, P. O. Box 2009 <br />Stockton, California 95201 <br />209/468-8781 <br />Jogl Khanna, M.D., M.P.H., District Health Officer <br />/fi✓ <br />8 / S, <br />%/(-0/Z o G S <br />Date of Inspection 6-3 —o' Inspector <br />Y 111 <br />SERVING <br />City of Lodi <br />San Joaquin County <br />City of Escalon <br />City of Manteca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <br />0 <br />MONITORING ALTERNATIVE #5 <br />nnual precision test on tank(s) and piping. <br />Daily inventory reconciliation with submission of quarterly statement <br />compliance with allowable variation. <br />Pip line 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 />regarding <br />Implementation of this monitoring alternative requires that the following CIRCLED items <br />be completed by the specified dates. p�/ <br />Precision test(s) must be performed by 7 3 0, o ° 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 />Document daily check of suction piping function starting immediately. <br />5. Submit quarterly statement to this office that allowable variation on inventory <br />reconciliation has not been exceeded or a list of dates and variations hat <br />exceeded allowable.* The first statement is due by Z-26 V� <br />60 2-3()2-3()p g Dispenser meter(s) must be calibrated by �O 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 -6 ectio/61 for <br />required actions. <br />3-86 UGT 1 <br />