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BOARD OF TRUSTEES S OAQUIN LOCAL HEALTH DISMCT SERVING <br /> James Culbertson. Pres. City of Lodi <br /> Patricia E. Vannuccl. Secy. 1601 East Hazelton Avenue' P.O. Box San Joaquin county <br /> Anthonette Van Spronsen City of Escalon <br /> Eat Pimentel Stockton,California 95201 City of Manteca <br /> Fern eugbee 209/46"781 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 Low San Joaquin County <br /> Facility Name <br /> n <br /> Address ® nA , <br /> Date of Inspection �—a1 -7 Inspector <br /> MONITORING ALTERNATIVE #5 <br /> _Annual precision test on tank(s) and piping. <br /> E.e" 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 thismonitoring alternative requires that the following CIRCLED items <br /> be completed by the specified dates. <br /> 1 . Precision test(s) must be performed by .3 oZ -$ and results sub fitted to <br /> this office within 30 days of the test. CT S+ -�o (qs-t on -b+,, f <br /> 2. Pipeline leak detectors must be installed on pressurized piping by <br /> 03. 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 /> , <br /> ((5. ) Submit quarterly statement to this office that allowable variation on inventory <br /> `✓ reconciliation has not been exceeded or a list of dates and v ri ti.gns that <br /> exceeded allowable.* The first statement is due by '7— QS-'"u <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 />