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BOARD OF TRUSTEES SAJQAQUIN LOCAL HEALTH 'DISTT SERVING <br />James Culbertson, Pres. City of Lodi <br />Patricia E. Vannuccl, Secy. 1 601 Bast Hazelton Avenue P. O. Box 2San Joaquin County <br />Anihonette van Spronsen 00'9 City of Escalon <br />Earl Plmeniel Stockton, Cal Iforn[a 95201 City of Manteca <br />Fern Bugbee 209/466-6781 City of Ripon <br />Daniel L. Flores City of Stockton <br />John D. Mast, M.D. City of Tracy <br />William J. Wade Jogl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br />Mary Anna Love San Joaquin County <br />Facility Name l`r 5r r.L_ <br />Address 611,4 V y 12R s , C 9S10 --- <br />Date of Inspection f,%-- /',�-�',% Inspector - <br />MONITORING ALTERNATIVE 15 <br />____Annual precision test on tank(s) and piping. <br />V Daily inventory reconciliation with submission of quarterly statement regarding <br />compliance with allowable variation. <br />- Pipeline leak detectors on pressurized piping. <br />t/Daily operational check of suction piping function. <br />Calibrated meters for inputs and withdrawals: <br />Weights and Measures sticker <br />� ertification 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 Z—,_/� 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 <br />watily inventory reconciliation must be started immediately, with records maintained <br />the facility for review. <br />::�� Document daily check of suction piping function starting immediately. <br />E5.,Aubmit quarterly statement to this office that allowable variation on inventory <br />reconciliation has not been exceeded or a list of dates and variatioa�_J�hat <br />exceeded allowable.* The first statement is due by / — 3% <br />O6Dispenser meter(s) must be calibrated by r S TT09,__ with copy of <br />certification or Weights and Measures sticker cumber submitted to this office. <br />If the above compliance dates cannot be met, contact this office prior to the specified <br />da to . <br />* If allowable daily inventory variation is exceeded, refer to Section 2644(f) for <br />required actions. <br />3-86 UGT 1 <br />