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BOARD OF TRUSTEES SM.DAQUIN LOCAL HEALTH DISTF.T SERVING <br /> James Culbertson, Pro$. City of Lodi <br /> Patricia E. Vannuccl, Secy. 1601 East Hazelton Avenue, P. 0. Box 2009 San Joaquin County <br /> Anthonotle Van Spronsen City of Escalon <br /> Earl Plmantel Stockton, Callfornla 95201 City of Manteca <br /> Fenn aupbas 209/468$781 City of Ripon <br /> Daniel L Florae <br /> City of Stockton <br /> John 0. Mut, M.D. City of Tracy <br /> William J. We" Joel Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Low (' San Joaquin County <br /> Facility Name 6 _ <br /> 4112 - J*,cp TA"t <br /> Address 202 - /=�irl�7° &e Y <br /> Date of Inspection (o a7'cF� Inspector 15-;ft;1LB <br /> �adPd T <br /> MONIT RING ALTERNATIVE 35 <br /> rl <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 detectorsion pressurized piping. <br /> Daily operational check of suction piping function. <br /> Calibrated meters for inputs and withdrawals: <br /> _Weights and Measures sticker <br /> i <br /> Certification by qualified repairman <br /> Implementation of this monitoring alternative requires that the following CIRCLED items <br /> be completed by the specified dates. p <br /> `l% Precision test(s) must be performed by 7- �7 —fsp and results submitted to <br /> this office within 30 days of the test. <br /> 0 Pipeline leak detectors must be installed. on pressurized piping by q -3 0-& K . <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 /> -5-1 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 �1,. <br /> 1151 _ __ <br /> 6.j Dispenser meter(s) must be calibrated by _ 1-�Z�_� __ __`_ 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 />