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i <br /> BOARD OF TRUSTEES SA*AQUIN LOCAL HEALTH DiSTf#T SERVING <br /> James Culbertson, Pres. City of Lodl <br /> cy. San Joaquin County <br /> Patricia E. Vannuccl, Se <br /> i 601 East Hazelton Avenue, P. Q. Box 2U09 City of Escalon <br /> Anthonette Van Spronsen City of Manteca <br /> Earl Plmentel StOCktOn, California 95201 <br /> City of Ripon <br /> Fern Bugbee 209/466-6781 City of Stockton <br /> Daniel L. Flores City of Tracy <br /> John 0. Mast, M.D. <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 (i1t"f) 55o� rG L�cc Q _ Mc' <br /> AddressS-05 'f_ < C <br /> Date of Inspection T �— -7 Inspector <br /> MONITORING ALTERNATIVE #5 <br /> I/ 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. <br /> �ZDaily 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 /> be completed by the specified dates. <br /> Precision test(s) must be performed by /0--3j—s 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 /> GDaily 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. 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 j _ ) �' <br /> CDispenser meter(s) must be calibrated by `! 0 —3 r` S 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 DGT 1 <br />