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BOARD OF TRUSTEES SAV IAQUIN LOCAL HEALTH DISTR� SERVING <br /> James Culbertson, Pros. City of Lodi <br /> Patitcla E. vannuoci, Secy. 1601 East Hazelton Avenue' P. O. Box 2009 San Joaquin County <br /> Anthonette Van Spronsen Cltyof Escalon <br /> Earf Plmentel Stockton, Cal I f orn la 95201 city of Manteca <br /> Fern Bupbee 209/466-6781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Mast, M.O. City of Tracy <br /> William J. Wade Joyl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> Facility Name Q n ��S �-�-� -J�7_ ;I- <br /> Address 3 C, E Y O U e , <br /> Date of Inspection Inspector n r D <br /> MONITORING ALTERNATIVE #5 <br /> Annual precision test on tank(s) and piping. <br /> .;tic; . *r;_ .x ra<,_ .`:.:`•,, ,nr r� .1 +C. ,, t : z < <br /> ✓Daily inventory reconciliation with submission of quarterly statement regarding <br /> compliance with allowable variation. <br /> L,-----Pipeline leak detectors on pressurized piping. <br /> Daily operational check of suction piping function. <br /> V"' 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) -ao4-results submitted to <br /> this office within 30 days -i-esf Fesu ( �s <br /> Pipeline leak detectors must be installed on pressurized piping by — - <br /> 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 /> 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 4— 1-5 ___F __7 <br /> 6. Dispenser meter(s) must be calibrated by _ _ _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 />