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•OARD of TRUSTEES SAN JMQUIN LOCAL HEALTH DIST I <br /> IT <br /> AnthanetN Van Spronaen • SERvfNQ <br /> Jamas Culbertson. Pres. City of Lodi <br /> Patricia E. V nucci, se1601 East Hazelton Avenue P. O. Box San Joaquin county <br /> , <br /> EaA Pirrasntsi Stockton,Galltornla 95241 City of EscaionCity of Manteca <br /> Daniellel <br /> Darn e 209/466-6781 City of Ripon <br /> LL.. Flores <br /> John D. Most. M.D. City of Stockton <br /> City of Tracy <br /> William J.Wade Jopi Khanna. M.D.. M.P.N.. District Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> Facility Name <br /> Address <br /> Date of Inspection --�� �S "a Inspector 0. <br /> MONITORING ALTERNATIVE 05 <br /> ✓Annual precision test on tank(s) and piping. <br /> ✓Daiiy -inventory reconciliation with submission of quarterly statement 'regarding <br /> compliance with allowable variation. <br /> ✓ Pipeline leak detectors pressurized piping. <br /> Daily operational check of suction piping function. <br /> v---' Calibrated meters for inputs and withdrawals: <br /> l✓ Veig is and Measures sticker <br /> Certification by qualified repairman <br /> Implementation of this:xmitoring alternative requires that the following CIRCLED items <br /> be completed by the specified dates. <br /> I . Precision test(s) must.be performed by and results submitted to <br /> this office within 30 days of the test. <br /> Pipeline leak de ectors lust be ins lied on_pressurized pipi g by <br /> C-z u�d r`.o i- Oe-r, 0 n spCAC, - u V-1.k e <br /> 3 J Daily inventory reconciliation �t be started immediately, with records maintained <br /> � Y <br /> at the facility for review. <br /> 4. Document daily check of suction piping function starting immediately. <br /> C5) 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 /> 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 /> i <br />