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BOARD OF TRUSTEES SASOAQUIN LOCAL HEALTH DISTOT <br /> James Culbertson, Pres. SERVING <br /> Patricia E. Vannuccl, Secy. City of Lodi <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2oo9 San Joaquin County <br /> Earl Plmentel Stockton, California 95201 City of Esealon <br /> Fern Bupbee City of Manteca <br /> Daniel L. Flores 209/486-8781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anna Love San Joaquin County <br /> San Joaquin County <br /> Facility Name <br /> Address <br /> Date of Inspection - ) - F Inspector <br /> MONITORING ALTERNATIVE 15 <br /> L-`-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 /> ti 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 /> OPrecision test(s) must be performed by 14- 1 5 --S 7 and results submitted to <br /> this office within 30 days of the test. <br /> Pipeline leak detectors must be installed on pressurized piping by 4-) s-�21 <br /> 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 /> 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 allowable. * The first statement is due by -7- I S <br /> 6. Dispenser meter(s) must be calibrated by <br /> copy of <br /> certification or Weights and Measures sticoer number submitted to this hoffice. <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 />