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BOARD OF TRUSTEES SAQPAQUIN LOCAL HEALTH DIS" SERVING <br />James Culbertson, Pres. City of Lodi <br />Patricia E. Vannuccl, Sec'y. 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br />Anlhonette Van Spronsen City of Escalon <br />Earl Pimentel Stockton, California 95201 City of Manteca <br />Fern Bugbee 209/466-6781 City of Ripon <br />Daniel L. Flores City of Stockton <br />John D. Mast, M.D. City of Tracy <br />William J. Wade Jog[ Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br />Mary Anna Love San Joaquin County <br />Facility Name <br />Addressy�^�� <br />Date of Inspection Inspector' <br />MONITORING ALTERNATIVE #5 <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 />Calibrated meters for inputs and withdrawals: <br />Weights and Measures sticker <br />_;,.�Dertification by qualified repairman <br />Implementation of this monitoring alternative requires that the following CIRCLED items <br />be completed by the specified dates. <br />1 <br />1.} Precision test(s) must be performed by �— and results submitted to <br />t 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 />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 <br />Dispenser meter(s) must be calibrated by 1���, 1 �� with copy of <br />certification or Weights and Measures sticker number�ubmitted 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 />