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Hazardous Materials Program Inspection Report Facility Name: YOSEMITE ST DIALYSIS CLINIC DAVITA Facility Address: 1650 W YOSEMITE AVE, MANTECA, CA 95337 Facility Phone: (209) 824-5552 Program: 1921 - HMBP-Regular-Primary Location Inspection Type: ROUTINE INSPECTION - Operating Permit Date: March 22, 2017 San Joaquin County Environmental Health Department 1868 East Hazelton Avenue, Stockton, California 95205-6232 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd CERS ID: 10187245 Inspection Contact: Adrian Agundez Consent For: Consent Given By: Adrian Agundez, Administrative Assistant Title: Administrative Assistanat Phone: (209) 814-5552 T Inspection T Photos £ Samples R = Repeat violation COS = Corrected on site during inspectioV = Violation CCR = California Code of Regulations HSC = Health and Safety Code CFR = Code of Federal Regulations Violations 1 □ V □ R □ COSFailed to pay annual operating feesSJO 4432 2 ■ V □ R □ COSFailed to complete and electronically submit a hazardous materials business planHSC 25505, 25508(a)(1) 3 ■ V □ R □ COSFailed to establish and implement a hazardous materials business planHSC 25507 4 ■ V □ R □ COSFailed to complete and/or submit the Business Activities or Owner/Operator Identification pageHSC 25508(a)(1) 5 ■ V □ R □ COSFailed to complete and/or submit hazardous materials inventory for all reportable materials on siteHSC 25506(a) 6 ■ V □ R □ COSFailed to complete and/or submit a site map with all required contentHSC 25505(a)(2) 7 ■ V □ R □ COSFailed to establish and/or submit emergency response procedures for a release or threatened releaseHSC 25505(a)(3) 8 ■ V □ R □ COSFailed to submit a training program or program is not reasonable or adequate for facilityHSC 25505(a)(4) 9 ■ V □ R □ COSFailed to annually review and certify that the business plan is complete, accurate, and up to dateHSC 25508.2 10 □ V □ R □ COSFailed to submit revisions to business plan within 30 days of substantial change in operationsHSC 25508.1(a)-(f) 11 □ V □ R □ COSFailed to provide or document initial and/or refresher training to appropriate personnelHSC 25505(a)(4) 12 ■ V □ R □ COSFailed to have the business plan readily available to facility or EHD personnelHSC 25505(c) 13 □ V □ R □ COSFailed to notify property owner that facility is subject to and in compliance with the HMBP programHSC 25505.1 14 □ V □ R □ COSFailed to report actual or threatened release to the EHD and/or CalOES Warning CenterHSC 25510 15 □ V □ R □ COSFailed to submit emergency response plan when not meeting Ag handler exemption requirementsHSC 25507.1 16 □ V □ R □ COSFailed to submit training program when not meeting Ag handler exemption requirementsHSC 25507.1 17 □ V □ R □ COSFailed to establish and implement a HMBP when not meeting remote unstaffed facility exemptionsHSC 25507.2 18 □ V □ R □ COSFailed to submit a written response within 30 days of receiving an inspection reportHSC 25511 1010 □ V □ R □ COSUnlisted Administration/Documentation violation See below 1040 □ V □ R □ COSUnlisted Release/Leaks/Spills violation See below SUMMARY OF VIOLATIONS (CLASS I, CLASS II, or MINOR - Notice to Comply) RemarksItem # Page 1 of 4