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3 3 <br />BOARD OF TRUSTEES SAWAOUIN LOCAL HEALTH DISAT 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 />Ead Plmentel Stockton, California 95201 y <br />City of Ripon <br />Fern Bupbee 209/466-6781 City of Stockton <br />Daniel L. Flores City of Tracy <br />John D. Mast, M.D. <br />William J. Wade Joel Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br />San Joaquin County <br />Mary Anna Love <br />Facility Name A-MAS>CI= Lih(�S <br />Address IA+ZrI i I� F� <br />Date of Inspection J.. 41- Inspector <br />MONITORING ALTERNATIVE #5 <br />l/ Annual precision test on tank(s) and piping. <br />�� 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 />j/ Calibrated meters for inputs and withdrawals: <br />/Weights and Measures sticker <br />V Certification by qualified repairman <br />Implementation of this monitoring alternative requires that the following CIRCLED items <br />bbe� completed by the specified dates. <br />U Precision test(s) must be performed by 8of� and results submitted to <br />l/ 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 />Document daily check of suction piping function starting immediately. <br />4. <br />USubmit quarterly statement to this office that allowable variation on inventory <br />reconciliation has not been exceeded or a list of dates and variatioQ5 that <br />exceeded allowable.* The first statement is due by -?-3 - '? <br />16.1 Dispenser meter(s) must be calibrated by —Zq —00 with copy of <br />`f 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 />