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SOAf%0 Of TRUSTEES SAN J( )UIN LOCAL HEALTH DISTRICT <br /> tERVINO <br /> Jam*• Culbaflaon, Praa. <br /> Lodi <br /> ►aincia E. vannuccl, SK'y. City of 16011 East Hazelton Avenue, P. O. Balt 2009 San Joaquin County <br /> AMhonolfa Van Saons•n <br /> Gly of EwAlon <br /> Ead PMnanlaf Stockton, Callfornla 95201' <br /> ' Gly ofMantantoc <br /> u <br /> Fwn avoboo 209/46"781 City of Ripon <br /> Daniel L. Flora City Of Stockton <br /> John D. Mast. M.D. City of Ttacy <br /> William J. Wada Jogf Khanna, M.D., M.P.H., Dlalncl Health olllcar San Joaquin County <br /> May Anna Low San Joaquin County <br /> Facility Name 3 <br /> Address X49, 5- PPryCFI,G �kU2. j_rlA! %� L109__ CJS 20 j <br /> Date of Inspection Inspector <br /> MONITORING ALTERNATIVE 15 <br /> /Annual precision test on tank(s) and piping. <br /> V Daily inventory reconciliation with submission of quarterly statement 'regarding <br /> /compliance with allowable variation. <br /> ---Lpipeline leak detectors on pressurized piping. <br /> Daily operational check of suction piping function. <br /> V Calibrated meters <br /> for inputs and withdrawals: <br /> L� Weights and Measures sticker <br /> Certification by qualified repairman <br /> Implementation of this. lixonitoring alternative requires that the following CIRCLED Stems <br /> be completed by the specified dates. <br />* b / 1 Precision test(s) must be performed by — 0`C� Land results submitted to <br /> this office within 30 days of the test. <br /> czf Pipeline leak detectors must be installed on pressurized piping by )— 30 - 7 <br /> 0 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 p $ - <br /> Dispenser meter(s ) must be calibrated by —37 __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, re ler to Section 2644( f ) for <br /> required actions . <br /> 3-86 UGT l <br />