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BOARD OF TRUSTEES $v JOAQUIN LOCAL HEALTH Mmoo1ICT SERVING <br /> James Culbertson, Pres. <br /> Patricia tt Vannuccl, sec'y. 1601 East Hazelton Avenue P. O. Box 2009 San Joaquin coup yl <br /> Anthonetle Ven Spronaen <br /> Earl Pimentel Stockton, California 95201City of Escalon <br /> Fern Bupbee ' city of Manteca <br /> Daniel L. Flores 209/468-8781 City of Ripon <br /> John D. Meet, M.D. City of Stockton <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer Cuof Tracy <br /> Mary Anna Love San Joaqui n County <br /> San Joaquin County <br /> Facility Name U/ < !!� b/w�k � <br /> Address /V,/ <br /> Date of Inspection Inspector <br /> MONITORING ALTERNATIVE #5 -h, 0 a� / '- t210CY)� <br /> L4nnual precision test on tank(s) and piping. <br /> L Daily inventory reconciliation with submission of quarterly statement regarding <br /> compliance with allowable variation. <br /> Pipeline leak detectors on pressurized piping. <br /> C--Daily operational check of suction piping function. <br /> a/ <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 /> be completed by the specified dates. <br /> 01thisPrecision tests) must be performed by and results submitted to <br /> office within 30 days of the test. / `> <br /> $at <br /> Pipeline leak detectors must be installed on pressurized piping byDaily inventory reconciliation must be started immediately, with records maintained <br /> 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 varitj s that <br /> exceeded allowable.* The first statement is due by <br /> 6. Dispenser meter(s) must be calibrated by c%/(--3 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 />