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•o^Ro of TRUSTEES SAN JO$UIN LOCAL HEALTH DISTRICT <br /> 1LEitvtfYO <br /> Jan►aa culbortson, Praa. - <br /> rald c" E. vannucci. S00. 1601 Joa ui y of Lott <br /> Anelwn�tt•Vary Spransan 1641 East Hazelton/lvenF.�e, � 0. Sax 2009 r q n county <br /> Gtr of Eacalon <br /> fEarf rtrrnrnlal Stockton. Callftxnla 95201 City of Mant.ca <br /> Firm Gupb" 209/466-6781 City of Ripon <br /> Danlal L. Floras City of Stockton <br /> John 0. blast. M.D. City of Tracy <br /> wintarn J. Wad• Jopi Khanna. M.D.. M.P.H.. District Health 0111car San Joaquin County <br /> Mary Anna Lara San Joaquin County <br /> Facility Name - 5,&6�-H N�SSJZ S G✓ffSf ' <br /> Address <br /> Date of Inspection / �3'- eG Inspector <br /> MONITORING ALTERNATIVE 15 <br /> V 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 /> [f Calibrated meters for inputs and withdrawals: <br /> Weights and Measures sticker <br /> Certification by qualified repairman <br /> Implementation of this:ntmitoring alternative requires that the following CIRCLED items <br /> completed by the specified dates. <br /> l Precision test(s) rust be performed by — 50— ' and results submitted to <br /> this office within 30 days of the test. <br /> 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 /> 4 . 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 variations that <br /> r� exceeded allowable. • The first statement is due by / — 3 — F 7 <br /> Dispenser meter(s ) must be calibrated by _/�- �_— with copy of <br /> certification or Weights and Measures sticker number submittedto this office. <br /> If the above compliance dates cannot be met , contact this office prior to the specified <br /> date. <br /> i <br /> If allowable daily inventory variation is exceeded. refer to Section 2644( f ) for <br /> required actions . <br /> 3-86 UGT I <br />