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""" """""' JNIV • //1V UIIV LVVHL IICNL) fl IIIJI rllV I SERVING <br /> James Cult neon, Pres. City of Lodi <br /> PatdCW E. vannuoci, Secy. 18ii East Hazelton Avenue, P. 0. Boz 2009 san Joaquin County <br /> Anthonette Ven 8pronsen Gty of Eeodon <br /> Earl Pknentol Stockton,California 95201 Ot of Mwaion <br /> Fern eupbee 209/4888781 City of Ripon <br /> antoos <br /> Danl*I L. Flora City of Stockton <br /> John O. Meet, M.D. City of Tracy <br /> William J. Wed* Joel Khanna, M.O., M.P.N., District Health Officer Sen Joaquin County <br /> Mary Anna Low San Joaquin County <br /> Facility Name i�f,aTEr . <br /> Address <br /> Date of Inspection —% Inspectory ;� ,� 5;- <br /> MONITORING ALTERNATIVE E5 <br /> 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 pipings!!'.n,'oTEr'62iFtgo ' Fnr7) <br /> Daily operational check of suction piping function. <br /> t/ Calibrated meters for inputs and withdrawals: <br /> _L Weights 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 -7 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 CMZ' F 7 <br /> 3. 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 /> 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 that <br /> exceeded allowable.* The first statement is due by ; <br /> 6. Dispenser meter(s) must be calibrated by _,_L_ 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 />