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SOARD Of TRUSTEES S •' OUIN L�At HEALTH UIS I SERVING <br /> Jamas Culbertson, Pro*. City of Lodi <br /> Patrtda E. Vannuocl, Secy. 1601 Eatlt Hazelton Avenue, P.O. Box 2009 San Joaquin County <br /> Anthonatto Van l3pronsen City of Eacalon <br /> Earl Pimentel Stockton, California 95201 City of Manteca <br /> Fern Bugbee 209/466-6781 City of Ripon <br /> DanW L. Flores City of Stockton <br /> John D. Moat, M.D. City of Tracy <br /> William J. Wade Joel Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Low San Joaquin County <br /> Facility Name 44G Q yo <br /> Address 1 1 l Y o s o�,►-- � <br /> Date of Inspection Inspector <br /> MONITORING ALTERNATIVE #5 <br /> ft.. Annual precision test�l 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 /> ✓Calibrated meters for inputs and withdrawals: <br /> eights 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 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 /> 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 /> 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 _��- -JS - 7 <br /> 6. 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 />