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t <br /> BOARD OF TRUSTEES <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Patricia E. Vannuccl, Sec'y. 1601 East Hazelton Avenue, P. O. Box 2009 San,Joaquln County <br /> Anthonette Van Spronsen City of Escalon <br /> Earl Plmentel Stockton, California 95201 City of Manteca <br /> Fern Bugbee 209/466 6781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jogl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> Facility Name <br /> Address wb <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 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 /> ✓Certification by qualified repairman <br /> Implementation of this monitoring alternative requires that the following CIRCLED items <br /> be completed by the specified dates. Na-le"Y bato_r <br /> Bly <br /> U I . Precision test(s) must be performed by i�i�rand 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 /> 6 Daily inventory reconciliation must be started immediately, with records maintained <br /> at the facility for review. <br /> 4L/ Document daily check of suction piping function starting immediately. <br /> r� <br /> Submit quarterly statement to this office that allowable variation on inventory <br /> / reconciliation has not been exceeded or a list of dates an� yyariations that <br /> exceeded allowable.* The first statement is due by 5'/(/f<& <br /> Dispenser meter(s) must be calibrated by (> 4CM&I& 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 <br />