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PI -19 <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.siaov.org/ehd <br />Underground Storage Tank Program Inspection Report <br />Facility Name: <br />Facility Address: <br />Date: <br />SUTTER TRACY COMMUNITY HOSP <br />1420 N Trac Blvd Trac <br />November 06 2015 <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 December 6, 2015. <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 />Notes: Assisted the facility with CERS by updating the information for the UST Facility Operating Permit and UST <br />Tank Information, reprinted current monitoring plan and updated response plan <br />Provided: Return to compliance <br />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br />Received ByReceived <br />�2 2? <br />By (printed name and title): <br />Plant Ops. Manager <br />Date: <br />(signature): <br />Pedro Gonzalez, <br />Inspector <br />Inspector (printed name and title): <br />Inspector Phone: <br />(signature): B <br />CINDY VO, EH Specialist <br />(209) 468-8257 <br />`_.1 Page 6 of 6 <br />