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80AJ40 "F TRUSTEES SAN OAQUIN LOCAL HEALTH DISTRJS- <br /> ZERVINQ <br /> .tames Culbertson, Prss. di <br /> Pslrkiu E. Vannuccl, Secy. City of Lodi <br /> o <br /> 1641 Lust Hazelton Avenue P. O. Box 2409 San Joaquin County <br /> Anlhonelte Van Spronsen ' City of Escalon <br /> EaA Plmenlel Stockton. Galllofnla 95241 City of Manteca <br /> Fern 8ugbee 209/46"781 City of Ripon <br /> Daniel L. Flores <br /> John D. Mast, M.D. City of Stockton <br /> City of Tracy <br /> William J. Wade Jopi Khanna. M.D.. M.P.H., District Health Officer San Joaquin County <br /> Mary Anne Love San Joaquin County <br /> Faci1 ity Name uUrr:.' ='f , ' C• <br /> Address <br /> Date of Inspection /( % ` ' Inspector <br /> MONITORING ALTERNATIVE 95 <br /> 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 /> Calibrated meters for inputs and withdrawals; <br /> Weights and Measures sticker <br /> C ' Certification by qualified repairman <br /> Implementation of this monitoring alternative requires that the following CIRCLET} items <br /> be completed by the specified dates. <br /> l: Precision test(s) must be performed byand 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 /> a <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 /> L5,-) Submit quarterly statement to this office that allowable variation on inventory <br /> reconciliation has not been exceeded or a list of dates and pa tions that <br /> exceeded allowable.* The first statement is due by <br /> Dispenser meter(s) must be calibrated by 11(2-14Z- <br /> with with copy of <br /> 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 /> 1 <br />