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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.ora/ehd Underground Storage Tank Program Inspection Report Facility Name: Facility Address: Date: lAugust SJ GENERAL HOSPITAL 500 W HOSPITAL RD FRENCH CAMP 17 2015 SUMMARY OF VIOLATIONS (CLASS 1, CLASS II, or MINOR - Notice to Comply) Item # Remarks 103 HSC 25292.2 Current financial responsibility documents not submitted. Financial responsibility documents have not been submitted to the EHD. Current financial responsibility documents are required to be submitted annually. Immediately log into the California Environmental Reporting System (CERS) at http://cers.calepa.ca.gov/, and upload the required documents. This is a repeat violation, Class II. 104 CCR 2711 UST Operating Permit Application for Facility and Tank information not submitted or current. UST Facility Operating Permit Application and UST Tank Information Certificate of Financial Responsibility, Chief Financial Officer, UST Site Map, UST Designated Operator Compliance, Monitoring Plan, and Response Plan are not current in CERS. These forms have not been submitted into CERS . Any change of information must be updated in CERS within 30 days of the changes. Immediately log into CERS, update the required information, and submit for review by the EHD. This is a Class II violation. 106 CCR 2632 Monitoring and response plans not current or approved by the EHD. The monitoring plan and Response is not current and/or not approved by the EHD. Monitoring Plan and Response Plan has not been submitted into CERS.. The monitoring plan and response plan must be uploaded to the California Environmental Reporting System (CERS). Immediately log into CERS, make the necessary changes, and submit for review by the EHD. This is a minor violation. 107 CCR 2632(d)(1)(C) Plot plan/site map not submitted or failed to completely show where monitoring is performed. An accurate UST Monitoring Site Plan was not submitted. A site plan must be submitted identifying the locations where monitoring will be performed. Immediately log into the California Environmental Reporting System (CERS) at http://cers.calepa.ca.gov/ and upload a copy of the UST Monitoring Site Plan. This is a minor violation. 113 CCR 2638(d) Failed to submit monitoring system certification test report within 30 days. Annual monitoring system certification, leak detector testing, and spill container testing was performed on August 22, 2014 and a test report was submitted on October 7, 2014 , 1.5 months late. A copy of the test report must be submitted within 30 days of the tests. Take all necessary precautions to ensure testing and submittal of test reports are performed in a timely manner. This is a minor violation. Received Inspector: Phone: Date: (initiaq: FATINAH ZAREEF, REHS (209) 953-7311 08/17/2015 // / Page 4 of 6