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BOARD OF TRUSTEES <br />James Culbertson, Pres. <br />Patricia E. Vannuccl, Secy. <br />Anthonette Van Spronaen <br />Earl Plmentel <br />Fern Bu®bee <br />Daniel L. Flores <br />John D. Mast, M.D. <br />William J. Wade <br />Mary Anna Love <br />Facility Name if <br />Address 3 <br />-30 <br />Date of Inspection <br />1601 East Hazelton• Box 2009 <br />Stockton, California 95201 <br />,t <br />Joel Khanna, M.D.. M.P.N., District Health Officer <br />Inspector <br />SERVING <br />City of Lodi <br />San Joaquin County <br />City of Escalon <br />City of Manteca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <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 />6? Precision test(s) must be performedy and results submitted to <br />this office within 30 days of the t st. <br />2. Pipeline leak detectors must be installerd,on pressurized piping by 144 <br />3. Daily inventory reconciliation must be started immediately, with records maintained <br />at the facility for review. <br />C, <br />Document daily check of suction piping function starting immediately. <br />5-., Submit quarterly statement to this office that allowable variation on inventory <br />reconciliation has not been exceeded or a list of dates Vvi tions that <br />exceeded allowable.* The first statement is due by /5 <br />6.; Dispenser meter(s) must be calibrated with copy of <br />certification or Weights and Measures sticker number submit ed 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 />