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BOARD OF TRUSTEES SA0AQUIN LOCAL HEALTH DIST <br />James Culbertson, Pres. <br />Patricia E. Vannuccl, Secy. 1601 East Hazelton Avenue, P. O. Box 2009 <br />Anthonette Van Spronsen <br />Earl Plmentel Stockton, California 95201 <br />Fern Bugbee 209/466-6781 <br />Daniel L. Flores <br />John D. Mast, M.D. <br />William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer <br />Mary Anna Love <br />Facility Name <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 />Date of • • •Inspector i • Jar ' i <br />MONITORING ALTERNATIVE #5 <br />Annual precision test on tank(s) and piping. <br />�R, c epDaily 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 />�R,5�m,A,Ee_ Calibrated meters for inputs and withdrawals: <br />R.ScmLAim 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 Gj-1-68 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 (0-1-Q'A <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 variatioQ\ns that <br />exceeded allowable.* The first statement is due by s('NI199 1 lS <br />6. Dispenser meter(s) must be calibrated by S L I S -1-5s 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 I <br />