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BOARD OF TRUSTEES SAI.._.jOAQUIN LOCAL HEALTH DISTr l.;T SERVING <br /> James Culberts8n, 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 /> Fern Bugbee 209/466-6781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> Facility Name �` ,/ (,, �;i �-fx��i /5'G2( 11�12 `,Y�,•-/�`r 7G� <br /> Address l�-�r'� '( 1 .7 1 ' jT �f��1�;v'jFc�k( 61, <br /> Date of Inspection Inspector <br /> MONITORING ALTERNATIVE #5 <br /> V 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 /> be completed by the specified dates. <br /> /V l 1.—pv�5 17.5 <br /> 1 . Precision test(s) must be performed by , 7j 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 /> 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 /> v reconciliation has not been exceeded or a list of dates and var.ations that <br /> exceeded allowable.* The first statement is due by <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 />