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3a . <br />�SOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br />James Culbertson, Pres. <br />Patricia E. Vannucci, Secy <br />Anthonette Van Spronsen <br />Earl Pimentel <br />Fern Bugbee <br />Daniel L. Flores <br />John D. Mast, M.D. <br />William J. Wade <br />Mary Anna Love <br />Facility Name <br />1601 East Hazelton Avenue, P. 0. Box 21-1t.,la' <br />Stockton,a 95201 <br />209/466-6781 <br />Jogl Khanna, M.D., M.P.H., District Health Officer <br />i <br />Address <br />Date of Inspection Inspector <br />SERVING <br />City of Lodi <br />San Joaquin County <br />City of Escalon <br />City of Manteca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <br />MONITORING ALTERNATIVE #5 %l #.21,e *_3 <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 />ZDaily operational check of suction piping function. <br />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 />01. Precision test(s) must be performed by 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 <br />Daily inventory reconciliation must be started immediately, with records maintained <br />at the facility for review. <br />L % Document daily check of suction piping function starting immediately_. <br />50. 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 al.lowable.* The first statement is due by i / 13,-- <br />6. <br />3,_ <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 <br />