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BOARD OF TRUSTEES SAN..)AQUIN LOCAL HEALTH DISTF T SERVING <br /> James Culbertson, Pres. `� City of Lodi <br /> Patricia E. Vannuccl, Selly. 1801 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Anthonstle Van Spronsen City of Esoalon <br /> Earl Pimentel Stockton, California 95201 City of Manteca <br /> Fern Bu9bee 209/488-6781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> Facility Name -21-p 4-aJw <br /> Address -- _� �SrsrrL/ <y1? �(�1��'>��l(• <br /> Date of Inspection 7i Inspector <br /> &jb( <br /> i <br /> MONITORING ALTERNATIVE #5 <br /> U 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 /> _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 /> pe completed by the specified dates. <br /> 14_ ). Precision test(s) must be performed by 7 and results submitted to <br /> L/ this office within 30 days of the test. <br /> 2. Pipeline leak detectors must be installed on pressurized piping by <br /> Daily inventory reconciliation must be started immediately, with records maintained <br /> l� at the facility for review. <br /> "'4. Document daily check of suction piping function starting immediately. <br /> C, <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 /a , 46- -7 <br /> Dispenser meter(s) must be calibrated by with copy of <br /> certification or Weights and Measures sticker nLimber 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 />