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qW <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: WWW.sjgov.org/ehd <br />Underrountlorage Tank Pgrarnitspectron Rep©rt <br />. p.- �.; <br />Facility Name: <br />Facility Address: <br />Date: <br />San Joaquin General Hospital <br />500 W Hospital Rd French Camp <br />August 21 2018 <br />Overall Inspection Comments: <br />Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br />documenting the corrective actions that have been or will be taken for each violation, and any supporting <br />paperwork, by September 20, 2018. <br />Note: No Owner/Operator Written Agreement submittal was made on CERS. <br />Note: Copies of the current financial responsibility documents were submitted on CERS, but were not available <br />on site. <br />Please be aware that as of January 1, 2014, facility operators are required to upload the following UST program <br />documents into the California Environmental Reporting System (CERS): UST Monitoring Site Plan, UST <br />Certification of Financial Responsibility, UST Response Plan, UST Letter from Chief Financial Officer(if <br />applicable), and the Owner Statement of Designated Operator Compliance. The UST Owner/Operator: Written <br />Agreement, if applicable, can be stored at the facility or uploaded into CERS. <br />Documents provided: Return to Compliance Certification form, schedule of free CUPA classes <br />AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING THIS <br />FACILITY BACK INTO COMPLIANCE <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br />Received by: Date: August 21, 2018 <br />Inspector: <br />Inspector Phone: <br />Printed Name and Title: <br />STACY RIVERA, Senior REHS <br />(209) 468-3440 <br />Nicholas Graham, designated operater <br />FA0000086 PR0231614 SC001 08/21/2018 <br />EHD 23-01 Rev. 09/22/16 Page 5 of 5 Underground Storage Tank Program OIR <br />