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SAN O U I Environmental Health Department .......... C u ail I y ,C1FOR?•.,. Greatness grows here, Underground Storage Tank Program Inspection Report Facility Name: Facility Phone: Date: Sutter Valley Hospitals dba Sutter Tracy Community Hospital (209)832-6032 November 06, 2019 Facility Address: CERS ID: 1420 N Tracy Blvd,Tracy, CA 95376 10397599 Inspection Contact: Title: Phone: Jason Simmons Plant Operations Manager (209)833-5698 Inspection Type: Program: ROUTINE INSPECTION-Operating Permit 12361 - UST FACILITY Consent For: Consent Given By: Ex Inspection Ex Photos Ex Samples Jason Simmons, Plant Operations Manager Service Technician Onsite: Exp.Date: Designated Operator: Exp.Date: Felix Ramirez 11/09/2020 David Winkler 02/04/2020 Service Technician Manufacturer's Training: VR, 07/07/20; SB, 11/29/19 CCR=Title 23 California Code of Regulations HSC=Health and Safety Code CFR=Code of Federal Regulations V=Violation R=Repeat violation COS=Corrected on site during inspection File Review = 1111 101 HSC 25284;CCR Failed to obtain a permit to operate from the EHD including but not limited to unpaid permit fees ❑V ❑R ❑COS 2711(d) 102 HSC 25284(a)(3)(A)/(B) No written agreement between tank owner and tank operator to monitor the tank system ❑V ❑R ❑COS 103 HSC 25292.2,25299.30 Failure to submit and maintain complete and current financial responsibility documents ■V ❑R ❑COS 104 CCR 2711 UST operating permit application for facility and tank information not submitted or current ❑V ❑R ❑COS 105 CCR 2632(d)(1), Failed to have an approved UST monitoring plan ❑V ❑R ❑COS 2634(d) 106 CCR 2632(d)(2), Failed to have an approved UST response plan ❑V ❑R ❑COS 2634(e) 107 CCR 2632(d),2641(h), Plot plan/site map not submitted or failed to completely show where monitoring is performed ❑V ❑R ❑COS 2711(a) 108 CCR 2637,2638(e), Failed to notify the EHD 48 hours prior to conducting testing ❑V ❑R ❑COS 2643(g) 109 CCR 2637(a-d),2712 Failed to test secondary containment,or failed to maintain test records for 36 months ❑V ❑R ❑COS 110 CCR 2637(e),2637(f) Failed to submit"Secondary Containment Testing Report Form"within 30 days after the test ❑V ❑R ❑COS 111 CCR 2638,26410), Failed to test monitoring and leak detection equipment every 12 months ❑V ❑R ❑COS 2715(f) 112 HSC 25293 Failure to maintain UST records to enable the UPA to determine whether the UST is in compliance ❑V ❑R ❑COS 113 CCR 2638(c),2638(d) Failure to submit"Monitoring System Certification Form"within 30 days of completion of the test ❑V ❑R ❑COS 114 CCR 2636(f)(3),2643(c) No 0.1 gph annual line integrity test for pressurized piping,or within 30 days after repair ❑V ❑R ❑COS (3) 115 CCR 2715(a)(1)(B), "Designated Underground Storage Tank Operator Identification Form"not submitted within 30 days ❑V ❑R ❑COS 2715(a)(3) 116 CCR 2715 Designated operator,service tech or installer did not possess current ICC certification ❑V ❑R ❑COS 117 CCR 2663, 2712(b)(6) Failure to comply with tank lining,recordkeeping,and inspection requirements ❑V ❑R ❑COS 118 CCR 2715(a)(1)(A), Failure to submit the"Underground Storage Tank Statement of Understanding and Compliance Form" ■V ❑R ❑COS 2715(a)(2) 119 HSC 25299(a)(8), Documents were falsified or misrepresented ❑V ❑R ❑COS 25299(b)(7) 120 CCR 2635(d) Failed to submit UST Certification of Installation/Modification ❑V ❑R ❑COS 121 CCR 2712(f) Failure to implement corrections and submit written response within 30 days of receiving the report ❑V ❑R ❑COS FA0002562 PR0231736 SCO01 11/06/2019 EHD 23-01 Rev.9/20/2019 Page 1 of 6 Underground Storage Tank Program OIR 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com