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BOARD OF TRUSTEES SAIp,JAQUIN LOCAL HEALTH DISThT0T SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Patricia tt Vannuocl, sec•y. 1601 East Hazelton Avenue San Joaquin y <br /> Anthonetle Van Spronasn , P. O. Box 2009 City of ECecalon <br /> Earl Plmentel Stockton, California 95201 ' City it of Manteca <br /> Fern Bupbee <br /> Daniel L. Flores 2097466-6761 City of Ripon <br /> City of Stockton <br /> John D. Most. M.D. City of Tracy <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anne Love ,�,� San Joaquin County <br /> Foci 1 i ty Name �/lAl 1 �r ;�yH7f/2f/CK <br /> Address x/10 `i C.F�rlic-rl� �%./�l_ tL ,flc�?Gy <br /> Date of Inspection /47-17 , ? Inspector <br /> MONITORING ALTERNATIVE ,95 <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: ;" NU! /�L(z �/,jr l�ItrS/�/V1 � <br /> Daily operational check of suction piping function. <br /> Calibrated meters for inputs and withdrawals: <br /> _Weights and Measures sticket-6 %tclelrl2 OoFled lr175.Oco) <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 /> / 1J Precision test(s) must be performed by and results submitted to <br /> IIJJ this office within 30 days of the test. <br /> Pipeline leak detectors must be installed on pressurized piping by <br /> 3/ Daily inventory reconciliation must be started immediately, with records maintained <br /> C! at the facility for review. <br /> 4. Document daily check of suction piping function starting immediately. <br /> 05 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 4/ 7 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 UU 1 <br />