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BOARD OF TRUSTEES SAIDAQUIN LOCAL HEALTH DISTF`T SERVING <br /> James Culbertson, Pros. City of Lodi <br /> Patricia E. Vannuccl, Sec'y. 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Anthonette Van Spronsen City of Escalon <br /> Earl Plmentei Stockton, Callfornia 95201 City of Manteca <br /> Fern Sugbes 209/466$761 City of Ripon <br /> Daniel L. Flora City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jogi Khanna, M.D., M.P.H., District Health Offker San Joaquin County <br /> Mary Anna Low San Joaquin County <br /> Facility Name �9n,�r�r3Tc7Z L� 6U'Sw <br /> Address 17 > <br /> Date ���c�-� Inspector <br /> MONITORING ALTERNATIVE #5 — rTy/� Al/ — �3 <br /> r/ Annual precision test on tank(s) and piping. <br /> wily inventory reconciliation with submission of quarterly statement regarding <br /> cgmpliance 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. <br /> 1 . Precision test(s) must be performed by and results submitted to <br /> this office within 30 days of the test. <br /> 2. Pipeline leak detectors must be installed. on pressurized piping by 6 ,�6 <br /> 3. 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 /> 5. 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 !o $ <br /> 6. Dispenser meter(s) must be calibrated by (,= h�b 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 />