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BOARD OF TRUSTEES SAM OAQUIN LOCAL HEALTH DIST`RCT SERVING <br /> City of Lodi <br /> James Culbertson, Pres. San Joaquin County <br /> Patricia E. Vannuccl, Secy. 1601 East Hazelton Avenue, P. O. Box 2009 City of Escalon <br /> Anthonette Van Spronsen City of Manteca <br /> Earl Plmentel Stockton, California 95201 <br /> ipon <br /> Fern Bupbee 209/466-6781 City of Stockton <br /> City of <br /> Daniel L. Flores City of Tracy <br /> John D. Mast, M.D. <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> San Joaquin County <br /> Mary Anna Love <br /> Facility Name <br /> Address f R6 h/1 <br /> Date of Inspection � Inspector / l +� ��"s C� <br /> MONITORING ALTERNATIVE #5 <br /> � Annual precision test ontank(s) and piping. <br /> Daily inventory reconciliation with submission of quarterly statement regarding <br /> compliance with allowable variation. <br /> ipeline leak detectors on pressurized piping. <br /> L/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 /> 1 . Precision test(s) must be performed by 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. <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 dat and vari tions that <br /> exceeded allowable.* The first statement is due by , 4 <br /> 6. Dispenser meter(s) must be calibrated by r I with copy of <br /> certification or Weights and Measures sticker numHer 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 /> EH 23 001 3/86 <br />