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r VAAN Vf ,Al/i,tu SAN JUAI.IUIN LUI:AL Ht ALU H UISI HKI SERVING <br /> James Culb odoon, Prea. City of Loll <br /> Patrtola E. v a'n` proocl. Socoon !_ 1 East Hazelton Avenue, P.O. Box 2009 sen Joaquin Cour <br /> Anlfanette Van 8proneen City of Eacalonn <br /> Earl Plawtol Stockton,California 95201 city of Manteca <br /> Fere Bugbee209/486-6781 Cllr of Ripon <br /> Fl <br /> Daniel L.. Flores <br /> John 0. Mast, M.O. city of Stockton <br /> William J. Wade Jogl Khanna, M.D.. M.P.H., District Health officer San J City of Tracy <br /> oaQuln county <br /> Mary Anna Low San Joaquin county <br /> Facility Name <br /> Address <br /> Date of Inspection - Inspector A <br /> MONITORING ALTERNATIVE /5 <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 /> - Gaily 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 /> Precision test(s) must be performed by____4 U N6 )'-'f��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 /> C ' 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 /> C5j 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 �]l +�J- C7) Int <br /> �6,, Dispenser meter(s) must be calibrated by �� a �� f' - with copy of <br /> certification or Weights and Measures sticker numbers bmitted 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 <br />