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BOARD OF TRUSTEES SAN ,I*QUIN LOCAL HEALTH DISTRIO SERVING <br /> City of Lodi <br /> James Culbertson, Pres. San Joaquin County <br /> Patricia E. Vannuccl, Secy. 1601 East Hazelton Avenue, P. O. Box 2009 City of Escalon <br /> Anthonette Van Spronsen Cit of Manteca <br /> Earl Pimentel Stockton, California 95201 y <br /> City of Ripon <br /> Fern Bupbee 209/466-6781 City of Stockton <br /> Daniel L. Flores City of Tracy <br /> John D. Mast, M.D. <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> San Joaquin County <br /> Mary Anna Love <br /> Facility Name QG�/�d�'✓ <br /> Address /V z6 .�1rYtC'D�ilti <br /> Date of Inspection 2AA7 Inspector <br /> MONITORING ALTERNATIVE #5 00c)r <br /> y Annual precision test on tank(s) and piping. <br /> Daily inventory reconciliation with submission of quarterly statement regarding <br /> compliance with allowable variation. <br /> A 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 /> A�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 IV ` <br /> �3 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 /> Submit quarterly statement to this office that allowable variation on inventory <br /> / reconciliation has not been exceeded or a list of dates anQl�� �s that <br /> exceeded allowable.* The first statement is due by CC�� �f <br /> Dispenser meter(s) must be calibrated by _ (— �7 with copy of <br /> v 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 />