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James Culbertson, Pres. <br />Patricia E. Vannuccl, Secy. <br />Anthonette Van Spronsen <br />Earl Pimentel <br />Fern Bugbee <br />Daniel L. Flores <br />John D. Mast, M.D. <br />Witham J. Wade <br />Mary Anna Love <br />Facility Name <br />Address 6 <br />SAN • ! `IN LOCAL HEALTH ": <br />1601 East Hazelton <br />• Box 2009 <br />Stockton,• _ 95201 <br />209/468-8781 <br />Jogi Khanna, M.D., M.P.H., District Health Officer <br />Date of Inspection -Z--26 _ " 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 /® yt <br />_/Annual precision test on tank{ ' ing. - <br />JZDaily 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 />Certification by qualified repairman <br />Implementation of this.monitoring alternative requires that the following CIRCLED items <br />be completed by the specified dates. <br />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 />Daily inventory reconciliation must be started immediately, with records maintained <br />at the facility for review. <br />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.l owabl e. * The first statement is due by 5 <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 0 <br />