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PUBL C HEALTH SERVICES aaUIN. <br /> SAN JOAQUIN COUNTY <br /> f: <br /> JOGI KHANNA M.D.,M.P.H. to <br /> Health Officer <br /> +c; <br /> P.O. Box 2009 • (1601 Gast Hazelton Avenue) Stockton,Cnliforni❑ 95201 <br /> (209) 468-3400 <br /> Facility Name <br /> Address <br /> Date of Inspection Inspector <br /> MONITORING ALTERNATIVE #5 <br /> Annual precision test on tank(s) and piping. <br /> Daily inventory reconciliation with submission of quarterly <br /> statement regarding compliance with allowable variation. <br /> Pipeline leak detectors on pressurized piping. <br /> Daily operational check of suction piping function. <br /> Cali ted 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 <br /> CIRCLED items be completed by the <br /> theme specified dates. <br /> 1. Precision tests) moiperformed � /v;�-db- - ?10 and results tisk ¢-- <br /> �� submitted to this office within 3o days of the test. <br /> 6::2 � Pipeline leak detectors must be installed on pressurized piping by <br /> L� /' -30 - g! . <br /> _ 3 . Daily inventory reconciliation must be started immediately, with <br /> -records maintained'at the facility for review. <br /> Document daily check of suction piping function starting <br /> immediately. <br /> ( 5. ) submit quarterly statement to this office that allowable variation <br /> on inventory reconciliation has not been exceeded or a list of <br /> dates and variations that exceeded allowable. *The first statement <br /> is due by z/ - /5- ?1/ <br /> Dispenser meter(s) must be calibrated by with a copy of <br /> certification or Weights and Measures sticker number submitted to <br /> this office, <br /> If the above compliance dates cannot be met, contact this office prior to <br /> the specified date. <br /> * If allowable daily inventory variation is exceeded, refer to Section <br /> 2644(f) for required actions. <br /> EH 23 001 4/89 <br /> A Division of San Joaquin Cnunty Health Cate Scrvires <br />