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BOARD OF TRUSTEES SOJOAQUIN LOCAL HEALTH DISI'F{ICT SERVING <br /> 'Jamaa Culbertson, Pres. City of Lodi <br /> Pa Viola Vannuccl, Secy. 1601 East Hazelton Avenue, P. 0. Box 2009 San Joaquin County <br /> Anthonetle Van Spronsen City of Eecelon <br /> Earl Plmentel Stockton, California 95201 City of Mentece <br /> ,rn Bupbee <br /> _anlel L. Flores 209/466-6781 City of Ripon <br /> John 0. Mast, M.D. City of Stockton <br /> City of Tracy <br /> William J. Wade <br /> Jog[ Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anne Love Sen Joaquin County <br /> Facility NameAl) <br /> Address OQ /Y//� //I� 5��1�1/ 9J�7�d 3 <br /> Date of Inspection Inspector Gt/ <br /> MONIT RING ALTERNATIVE d5 <br /> 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. R E C E I V E D <br /> /Calibrated meters for inputs and withdrawals: JAN 10 NJ <br /> Weights and Measures sticker <br /> D A6oRTM TNT <br /> Certification by qualified repairman <br /> Implementation of this monitoring alternative requires that the following CIRCLED items <br /> be completed by the specified dates. �r <br /> Precision test(s) must be performed by and resultsub itted t <br /> this office within 30 days of the test. G'^ 6t <br /> 2. Pipeline leak detectors must be installed on pressurized piping by <br /> (9 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 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 varitjons that <br /> exceeded allowable."' The first statement is due by 3 — 3d — �� <br /> C> Dispenser meter(s) must be calibrated by -2—��— with copy of <br /> certification or Weights and Measures sticker number submitted to this office. <br /> f 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 />