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BOARD ul TRUSTEES S, ,OAQUIN LOCAL HEALTH DIST <br /> James Cult>eAson, Pru. W ,,.,,.oT SERVING <br /> Patricia E. Vannuccl, S•c'y. City of Lodi <br /> Antnon•tle Van Sprons" 1801 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Plmontel Stockton, California 95201 City Of Eacalon <br /> F•m Bugbee City of Manteca <br /> Daniel L. Florae 209/488-6781 City of Ripon <br /> John D. Mast, M.D. City of Stoc ion <br /> William J. Wad* Clty of Tracy <br /> Joel Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Low San Joaquin County <br /> Fac iI ity Name <br /> Address �7�9 l�d a, �•,o. �><acr; Sircl J� <br /> Date of Inspection / �gg Inspector , fypC. <br /> MONITORING ALTERNATIVE 15 <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 /> .ZCalibrated teeters for inputs and withdrawals: <br /> Weights and Measures sticker <br /> I <br /> L,, Certification by qualified repairman <br /> Implementation of this monitoring alternative requires that the following CIRCLED items <br /> be completed by the specified dates. <br /> 10 Precision test(s) must be performed by ? a S$� 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 /1/-A, <br /> 3 Daily inventory reconciliation must be started immediately, with records maintained <br /> at the facility for review. <br /> l 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 /> exceeded allowable.* The first statement is due by e/A571k9 <br /> 6. Dispenser meter(s) must be calibrated by Al,A 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 />