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BOARD OF TRUSTEES SAN " )AQUIN LOCAL HEALTH DISTRI- ' SERVING <br /> James Culbertson, Pres., of City of Lodi <br /> Patricia E. Vannuccl, SeC'y. 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Anthonatte Van Spronsen City Of Escalon <br /> Earl Pimentel Stockton, California 95201 City of Manteca <br /> City of Ripon <br /> Fern Bupbas 209/466-6761 <br /> on <br /> Daniel L. Flores City it of Tracy <br /> r cy <br /> John D. Mast. M.D. City of County <br /> William J. Wade Jogi Khanna, M.D., M.P.M., District Health Officer San Joaquin County <br /> Mary Anna Love <br /> San Joaquin County <br /> Facility Name rnll~ l � <br /> Address Z <br /> Date of Inspection t� �c�' a Inspector <br /> Q <br /> MONITORING ALTERNATIVE 05 — lU TUU <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. <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 /> 71this <br /> ompleted by the specified dates. <br /> Precision test(s) must be performed by 1/ / $ and results submitted to <br /> 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 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 date and variations. that <br /> exceeded allowable.* The first statement is due byb/ (yti / 0 $�' <br /> Dispenser meter(s) must be calibrated by p3 ( r with copy of <br /> certification or Weights and Measures sticker 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 />