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BOARD OF TRUSTEES SASIOAQUIN LOCAL HEALTH DISTVT SERVING <br /> James Culberieon, Pres. City of Lodi <br /> Patricia E. Vannuccl' Secy' 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Anthonelle Van Spronaen City of Esalon <br /> Eari Plmentel Stockton, California 95201 City of Manteca <br /> Fem Bugbee 209/466$781 City of Ripon <br /> Daniel L. Flora City of Stockton <br /> John D. Most. M.D. City of Tracy <br /> William J. Wade Joel Khanna, M.D., M.P.H., District Health Off lar San Joaquin County <br /> Mary Anna Low San Joaquin County <br /> Facil ity Name _ AE#/LS <br /> Address <br /> Date of Inspection Inspector -%744104 Fdy//4 <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 /> 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 3-,Zf —�`�( and results submitted to <br /> this office within 30 days of the test. <br /> 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 /> 5. 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 /5"ffF <br /> 6. Dispenser meter(s) must be calibrated by _/,�' //-8� 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 />