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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.sigov.org/ehd Underground Storage Tank Program Inspection Report Facility Name: Facility Address: Date: SJ GENERAL HOSPITAL 500 W HOSPITAL RD FRENCH CAMP August 17 2015 SUMMARY OF VIOLATIONS (CLASS I, CLASS 11, or MINOR - Notice to Comply) Item # Remarks 125 CCR 2712(f) Failed to submit a written response within 30 days of receiving an inspection report. An inspection was last done on August 22, 2014 and an inspection report was issued identifying information to be submitted to bring this site into compliance. This information was required to be submitted by September 22, 2014. This information has not been received resulting in a non-compliant status for this facility. An operator that receives an inspection report shall have 30 days to submit a written response that includes a statement documenting corrective actions taken or proposing corrective actions which will be taken. Ensure that a written response documenting corrective actions taken or proposed is submitted within 30 days of receiving an inspection report. The violation not address is 999. HSC 25404 (e)(4). Electronic submittal to the California Environmental Reporting System is not up to date and not all the required information has not been uploaded. This is a Class II violation. 126 HSC 25404(e)(4) Failed to report program data electronically. A submission to the California Electronic Reporting System (CERS) for the underground storage tank (UST) program has not been made. Beginning January 1, 2014, all businesses are required to submit all new (or any changes to existing) UST information, including: UST Monitoring Site Plan, UST Certification of Financial Responsibility, UST Response Plan, UST Owner/Operator Written Agreement (if applicable), UST Letter from Chief Financial Officer, and Owner Statement of Designated UST Operator Compliance online to the CERS at http://cers.calepa.ca.gov. Be sure to include any other relevant activities and required fields. This is a repeat violation, Class II. Overall Inspection Comments: Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement documenting the corrective actions that have been or will be taken for each violation, and any supporting paperwork, by September 16, 2015 . Please be aware that as of January 1, 2014, facility operators are required to upload the following UST program documents into the California Environmental Reporting System (CERS): UST Monitoring Site Plan, UST Certification of Financial Responsibility, UST Response Plan, UST Letter from Chief Financial Officer (if applicable), and the Owner Statement of Designated Operator Compliance. The UST Owner/Operator: Written Agreement, if applicable, can be stored at the facility or uploaded into CERS. NOTES: Jesse Berumen Site Sentinel C-00139217 expires 11-7-15 The service technician Felix Rameriz Certificate for Petro Tite Expired 8-7-2015. The line test will need to be performed before the end of August 2015. A 48 hour notification needs to be submitted to the EHD. Received b Inspector: Phone: Date: (initial): FATINAH ZAREEF, REHS (209) 953-7311 08/17/2015 // Page 5 of 6