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BOARD OF TRUSTEES S/SJOAQUIN LOCAL HEALTH DIST � 8ERviN0 <br /> City of Lodi <br /> James Culbertson, Pres. San Joaquin County <br /> Patricia E. Vannuccl, SeC'y. 1601 East Hazelton Avenue, P. ©. Box 20(19 City of Escalon <br /> Anihonetio Van Spronsen City of Manteca <br /> Earl Plmentel Stockton, California 95201 City of Ripon <br /> Fem Bugbee 2091468-0781 City of Stockton <br /> Daniel L. Flores City of Tracy <br /> John D. Most. M.D. <br /> William J. Wade Joel Khanna, M.o., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Lore San Joaquin County <br /> Facility Name _ <br /> Address i <br /> Date of Inspection "6` Inspector U` <br /> MONITORING ALTERNATIVE #5 <br /> 'Annual precision test on tank(s) and piping. <br /> wily inventory reconciliation with submission of quarterly statement regarding <br /> compliance with allowable variation. <br /> Pipeline leak detectors on pressurized piping. <br /> wily operational check of suction piping function. <br /> ::�Calibrated meters for inputs and withdrawals: <br /> We'ghts 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 -"� --Oland pf and results submitted to <br /> this office within 34 days of the test. <br /> 2. Pipeline leak detectors must be installed on pressurized piping by <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 tV <br /> exceeded allowable.* The first statement is due by <br /> 6. Dispenser meter(s) must be calibrated by '2S 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. - _ r- -� <br /> 3-8b UGT 1 <br />