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SERVING <br /> BOARD OF TRUSTEES S ' JOAQUIN LOCAL HEALTH DIST*CT City of Lodi <br /> James Culbertson. Pres. San Joaquin County <br /> �Patricta E. Vannucci, Secy. 1601 East Hazelton Avenue, P. O. BOX 2009 City of Escalon <br /> Anthonetts Van SpronsenCity of Manteca <br /> arPmenter Stockton, California 95201 City of Ripon <br /> li <br /> f=armente 209/466-6781 City of Stockton <br /> City of Tracy <br /> Daniel L. Flores San Joaquin County <br /> John D. Mast, M.D. Jogi-Khanna, M.D.. M.P.H.. District Health officer San Joaquin County <br /> William J. Wade <br /> Mary Anna love <br /> Facility Name <br /> Address <br /> c <br /> Date of Inspection inspector <br /> MONITORING ALTERNATIVE #5 <br /> Annual precision test on tank(s) and piping. <br /> VDaily inventory reconciliation with submission of quarterly statement regarding <br /> compliance with allowable variation. <br /> 11� pipeline leak detectors on pressurized piping. <br /> 70' ily operational check of suction piping function. <br /> Calibrated ed meters for inputs and withdrawals: <br /> Weights and Measures sticker <br /> i/ Certification by qualified repairman <br /> implementation of this monitoring alternative requires that the following CIRCLED items <br /> e completed by the specified dates. <br /> VO <br /> and results submitted to Precision test(s) must be performed by <br /> this office within 30 days of the test. <br /> 2. Pipeline leak detectors must be installed on pre(35 ssurized 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 immediatel . <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 var ations that <br /> exceeded allowable.* The first statement is due by r` <br /> with copy of <br /> do Dispenser meter(s) must be calibrated by <br /> 6'— —A7 <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 />