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30ARD OF TRUSTEES S OAQUIN LOCAL HEALTH DISOCT SERVING <br /> acnes Culbertson, Pre*. City of Lodi <br /> Patricia E. Vannuccl, SecySan Joaquin County <br /> Anthonetle Van Spronsen, ifi01 East Hazelton Avenue, P. 0. Box 2049 City of Escalon <br /> Earl Pimentel Stockton, California$5241 City of Manteca <br /> Fern Bugbea 209/466-5781 City of Ripon <br /> Daniel L. Flores CIly of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jog) Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> Facility Name "�- <br /> Address <br /> J- <br /> Date of Inspection 3 2/ Inspector r 1 <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 /> Vl 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 /> l) Precision test(s) must be performed by 5-,')0 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 <br /> 03 Daily inventory reconciliation must be started immediately, with records maintained <br /> at the facility for review. <br /> (0 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 2f1 1_ <br /> Dispenser meter(s) must be calibrated by 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 />