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BOARD OF TRUSTEES SAh,,,,)AQUIN LOCAL HEALTH DIM,; SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Patricia E. Vannuccl, Secy. 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin county <br /> Anthonette Van Spronsen City of Escalon <br /> Earl Plmentel Stockton, California 95201 City of Manteca <br /> Farm Bubee <br /> 0 209/466-6761 City of Ripon <br /> Daniel L. Flores _ City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William <br /> tLv �� j Jopl Khanna. M.D., M.P.H., District Health Officer San Joaquin County <br /> Maty Anna oe <br /> T San Joaquin County <br /> Facility Name <br /> Address 'goo /�I�LLoi✓ �G — Gf3 �/J's'�� <br /> Date of Inspection 7 Inspector <br /> MONITORING ALTERNATIVE #5 <br /> VAnnual precision test on tank(s) and piping. <br /> __L,-'Daily inventory reconciliation with submission of quarterly statement regarding <br /> compliance with allowable variation. <br /> Pipeline leak detectors on pressurized piping. <br /> k/Daily operational check of suction piping function. <br /> __ZCalibrated 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. G <br /> Precision test(s) must be performed by ,S O 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 variati��gqns that <br /> exceeded allowable.* The first statement isdueby <br /> 6. Dispenser meter(s) must be calibrated by / S Y7 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 />