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R <br /> ♦ J <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTOCT SERVING <br /> James Culbertson, Pre&. 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 Bupbee 209/466-6781 City of Ripon <br /> Daniel L. Flores <br /> City of Stockton <br /> John D. Mast, M.D. <br /> 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 /> F a c i 1 i ty Name <br /> Address <br /> Date of Inspection ,'�- �� Inspector <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 /> 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 /> I . Precision test(s) must be performed by 'r? and results submitted to <br /> this office within 30 days of the test. <br /> f1� 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 /> V reconciliation has not been exceeded or a list of dates and variations that <br /> exceeded allowable.* The first statement is due by �_ n4'&4 <br /> Dispenser meter(s) must be calibrated by _� � with copy of <br /> certification or Weights and Measures sticker n`Gmbes itted 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 />