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BOARD TRUSTEES SAtv�JOAQUIN LOCAL HEALTH DISTRICT <br /> James Culbertson, Pros. SERVING <br /> Patrlcla E. Vannuccl, Secy. City of Lodi <br /> Anthonette Ven Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Plmentel StocktonCall(Ofn1895201 City of Escalon <br /> , <br /> Fern Bugbee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wade Jopi 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 I Inspector <br /> MONITOORING ALTERNATIVE #5 2/000� 7 64 <br /> V Annual precision test on tank(s) and piping. <br /> Daily inventory reconciliation with submission of quarterly statement regarding <br /> compliance with allowable variation. <br /> y 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 /> Abe completed by the specified dates. <br /> 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 /> 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 ond variations that <br /> exceeded allowable.* The first statement is due b <br /> Dispenser meter(s) must be calibrated by � <br /> copy of <br /> certification or Weights and Measures sticumbt� omitted to thisiwith <br /> ker noffice. <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 />