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SOARO OF TRUSTEES SAN J QUIN LOCAL HEALTH DISTRIC SERVING <br /> J�Msa Culbertson, Pres. City of Lodi <br /> Patricia E. V nuccl, Secy. t 601 Ea3t Hazelton Avenue P. O. Box 2009 San Joaquin County <br /> Anthonetle Van Spronsen City of Eacalon <br /> Earl Pimentel Stockton, Callfornla 95201 ' City ity o Manteca <br /> Fern l L. Fl 2091466-6781 City of Ripon <br /> Daniel L. Flores <br /> John D. Mast, M.D. City of Stockton <br /> City of Tracy <br /> William J. Wade Jopl Khanna, M.O.. M.P.H.. District Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> i <br /> i <br /> Facility Name <br /> Address7YA(�„u�; <br /> Date of Inspection Inspector <br /> MONITORING ALTERNATIVE #5 <br /> i 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 /> 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 <br /> (s) must be performed by '-Z///1), 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 /> 5. Submit quarterly statement to this office that allowable variation on inventory <br /> reconciliation has not been exceeded or a list of dates an - variations that <br /> exceeded allowable.* The first statement is due by <br /> 6. Dispenser meter(s) must be calibrated by ;y' with copy of <br /> certification or Weights and Measures sticker number submitted to this office. <br /> I <br /> If the above compliance dates cannot be met, contact this office prior to the specified <br /> date. 4 <br /> * If allowable daily inventory variation is exceeded, refer to Section 2644( f) for <br /> required actions. ;. <br /> 3-86 UGT 1 <br />