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a0AR0 Of TRUSTEES SAN JP AQUIN LOCAL HEALTH DISTRICT - SERVING <br /> Jamas Culbertson. Pre$. City of Locil <br /> Patricia E. Vannuccl, Soc'y. 1601 Haat Hazelton Avenue, P. O. Box 2009 '" San Joaquin County <br /> Anthon tto Van Spronsen City of Escafon <br /> Earl PimarNef I Stockton, Callfomla 95201City of Manteca <br /> Fern aupbea ;eA�' <br /> 209/466.6781 City of Ripon <br /> D"IN L. Floras City of Stockton <br /> John D. Mut, M.D. City of Tracy <br /> William J. Wade Joel Khanna. M.D.. M.P.W. District Health Officer San Joaquin County <br /> Mary Anna low San Joaquin County <br /> Facility Name �D�Z7 0�" S7aGK70.v l iS74i`fju7oeS .Z A,' <br /> Address ?EE� 1k71rve'e 4E_ <br /> J'KN G1k �S?� S <br /> Date of Inspection /D- Z�/—�b Inspector <br /> MONITORING ALTERNATIVE 05 <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 /> /�Oaily operational check of suction piping function. <br /> V Calibrated meters for inputs and withdrawals: <br /> "eights and Measures sticker <br /> __�/Certifir_atlon by qualified repairman <br /> Implementation of this. monitoring alternative requires that the following CIRCLED items <br /> be completed by the specified dates. <br /> urea Precision test(s) must be performed by /v7—/6—F� and results submitted to <br /> �J this office within 30 days of the test. <br /> 2. Pipeline leak detectors must be installed on pressurized piping by <br /> (3) Daily inventory reconciliation must be started imnediately, with records maintained <br /> ��// at the facility for review. <br /> 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 7 _ <br /> 6'. Dispenser meter(s) must be calibrated by /Z����� 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 I <br /> I <br />