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San Joaquin County Will Environmental Health Department 1868 East Hazelton Avenue, Stockton, California 95205-6232 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd �F i ! ;pp d{� fir- 7s> v Ji 3 � " `' _ �q�+s ■ ``"` 1 '� a J i i !t `'�,"�h ,!!!ti °Si�9�IiWl,�a G , ., G6,�Ii\+II� ��♦� rr`� a - ��-�� .... de� �i4/�1�� ®I i„ ..�+,M.� €�a _ ,i,c,i, . Facility Name: Facility Phone: Date: SUTTER TRACY COMMUNITY HOSP (209) 835-1500 November 04, 2016 Facility Address: CERS ID: 1420 N Tracy Blvd, Tracy, CA 95376 10397599 Inspection Contact: Title: Phone: Pedro Gonzalez Plant Op Assist Manager (209) 833-5698 Inspection Type: Program: ROUTINE INSPECTION -Operating Permit 2361 - UST FACILITY Consent For: I Consent Given By: ® Inspection ® Photos ® Sam les I Pedro Gonzalez, Plant Op Assistant Manager Service Technician Onsite: Exp.Date: Designated Operator: Exp.Date: David Winkler 03/01/2018 David Winkler 02/26/2018 Service Technician Manufacturer's Training Veeder Root,02/03/18; Tank Tester,03/31/17 CCR=California Codeo egu ations HSC=Health and Safety Code CFR=Code of a eral Regulations V=Violation R=Repeat violation COS=Corrected on site during inspection W 101 HSC 25284 No permit to operate ❑V ❑R ❑COS 102 HSC 25284(a)(3) No written agreement between tank owner and tank operator to monitor the tank system ❑V ❑R ❑COS 103 HSC 25292.2 Current financial responsibility documents not submitted ■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 106 CCR 2632(d)(2) Failed to have an approved UST response plan ■V ■R ❑COS 107 CCR 2632(d)(1)(C) Plot plan/site map not submitted or failed to completely show where monitoring is performed ■V ■R ❑COS 108 CCR 2637(f),2638(e) Failed to notify the EHD 48 hours prior to conducting testing ❑V ❑R ❑COS 109 CCR 2637 Failed to test secondary containment ❑V ❑R ❑COS 110 CCR 2637(e) Failed to submit secondary containment test report within 30 days ❑V ❑R ❑COS 111 CCR 2638(a) Failed to test monitoring and leak detection equipment annually ❑V ❑R ❑COS 112 HSC 25284.2 Failed to test spill containers annually ❑V ❑R ❑COS 113 CCR 2638(d) Failed to submit monitoring system certification test report within 30 days ❑V ❑R ❑COS 114 CCR 2636(f) Failed to perform 0.1 gph annual line test for pressurized piping without fail safe or shut down ❑V ❑R ❑COS 115 CCR 2715(a) Failed to inform the EHD of designated operator identification or change within 30 days ❑V ❑R ❑COS 116 CCR 2715 Designated operator,service tech or installer did not possess current ICC certification ❑V ❑R ❑COS 117 CCR 2663 Failed to inspect a lined or repaired steel tank within 10 years of lining and every 5 years after ❑V ❑R ❑COS 118 CCR 2663 Failed to submit tank lining certification within 30 days or to conduct proper tests ❑V ❑R ❑COS 119 HSC 25299 Documents were falsified or misrepresented ❑V ❑R ❑COS 120 CCR 2635(d) Failed to submit UST Certification of Installation/Modification ❑V ❑R ❑COS 121 CCR 2712(f) Failed to submit a written response within 30 days of receiving an inspection report ❑V ❑R ❑COS 122 CCR 26310) Failure to submit UST system component statement of compatibility for substance stored ❑V ❑R ❑COS �iaa .;i; ✓d''f1 �,!� ,x* �}'i' a$JC7"sa ;z:.x' "---_`-'�-� i it8 i!0.5r' "".moi �r g ,^�.h r:.. t .. _ ea -^m aZr . j r E' iy'S �ry °,�� jl'b7..r7Rn"sax. Ff�! °'� ✓ �it�(4tl%ii1i�3.;a��;r v �r.r� N,as PSI.G:es li ::,.' ip sEaM.,,ii air%rF =`r`= � i , ,2� i�, .( i 201 CCR 2712(b) Failed to maintain alarm logs and/or records of follow up actions ■V ■R ❑COS 202 CCR 2712(b) Failed to maintain cathodic protection test records on site for at least 6 1/2 years ❑V ❑R ❑COS 203 CCR 2712(b) Failed to maintain records of monitoring,repair, lining,and upgrades on site ❑V ❑R ❑COS FA0002562 PR0231736 SCO01 11/04/2016 EHD 23-01 Rev.09/22/16 Page 1 of 6 Underground Storage Tank Program OIR