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1 � <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Patricia E, Vannuccl, sec'y. 1601 East Hazelton Avenue P. O. Box 2009 San Joaquin County <br /> Anthonette Van Spronsen City of Escalon <br /> Earl Pimentel Stockton, California 95201 City of Manteca <br /> Fern Bugbee 209/466-8781 City of Ripon <br /> Dance! L. Flores City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jog[ Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> Faci l i ty Name AZ tje- �a:5 j ,�E,CeC J`/1.L v CCI1 Gt ✓/L ? ar, <br /> Address , <br /> Date of Inspection _3 -5-- 5?' Inspector <br /> MONITORING ALTERNATIVE #5 <br /> Annual 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 /> __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 /> be completed by the specified dates, <br /> t <br /> Precision test(s) must be performed by -5-- -Y&Iand results submitted to <br /> u 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 /> at the facility for review. <br /> Document daily check of suction piping function starting immediately. <br /> 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 al.lowable.* The first statement is due by <br /> Dispenser meter(s) must be calibrated by <br /> _A- with copy of <br /> certification or Weights and Measures sticker rrMi r sMitted 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 <br />