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BOARD OF TRUSTEES SA AQUIN LOCAL HEALTH DIST* SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Patricia E. Vannuccl, Secy. San Joaquin County <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 City of Escalon <br /> Earl Plmentel Stockton, California 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 /> Fac i l i ty Name l Val g- <br /> Address /O 'r'�' <br /> Date of Inspection Inspector 4/ _ ` <br /> MONITORING ALTERNATIVE ,#5 ����000 r <br /> l-'�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 /> 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 /> be completed by the specified dates. <br /> 1� Precision test(s) must be performed by 11 and results submitted to <br /> this office within 30 days of the test. <br /> 17 <br /> 2 Pipeline leak detectors must be installed on pressurized piping by <br /> '37 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 and vari tons that <br /> exceeded allowable.* The first statement is due by / / <br /> Lo Dispenser meter(s) must be calibrated by i l '' _ <br /> � ll � r 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 />