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BOARD <br /> OF TRUSTEES �AQUIN LTZAL-HEALTH DIS <br /> James <br /> emes Culbertson, Prea. SERVING <br /> Patricia E. Vannuccl, Secy. City of Lodi <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Plmentel Stockton, Callfornla 95201 City of Escalon <br /> Fern Bupbee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Rlpon <br /> John D. Most, 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 �l N l� FI` , Sr--- gp, <br /> Address —__l�j q qLf (� 5� LN G <br /> l <br /> Date of Inspectio91:: �Z_____ 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 /> Zaily operational check of suction piping function. <br /> Calibrated meters for inputs and withdrawals: <br /> Weights and Measures sticker 0K <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 /> Qthis recision test(s) must be performed by C{— 3 — 87 and results submitted to <br /> office within 30 days of the test. <br /> 2. Pipeline leak detectors must be installed on pressurized piping by <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 /> Submit quarterly statement to this office that allowable variation on inventory <br /> reconciliation has not been exceeded or a list of dates and variati ns_that <br /> exceeded allowable. * The first statement is due by — (� <br /> 6. Dispenser rneter(s) must be calibrated by <br /> certification or Weights and Measures sticker number submitted to thishoffice.copy 0/4C: <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 /> 86 UGT 1 <br />