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Feb.27. 2015 1:49PM A FACILITIES MGMT <br />• No9162 P. 4 <br />NECEIVEL?- <br />San <br />Joaquin County <br />EnAronmental Health Department <br />1868 haat Hazelton Avenue, WaWn, Callfbihia 95205-6232 <br />Telephone. (209) 468-3.420 F4K,, (209) 468-3433 Weib., slaov.oralehd <br />Padh 1 8* R <br />SUTTetj TRACY COMMUNITY HOSP <br />Foallity phone? <br />1(209) 835-1500 <br />Data: <br />November 21, 2014 <br />FaellifyAddress! <br />EPA ID; <br />1 <br />CERB 10; <br />10307699 <br />1420 N TRACY BLVD, TRACY, <br />CA 95376 <br />Mello Conlach <br />Contact Phone: <br />0"dacl during lnopo@tlon, It <br />1dlffWAl;ftW1!W*llKYc0rftcl:%)M <br />11 ITTER TRACY COMMUNITY (209) 836-1500 <br />Inspection type: program: <br />ROUTINE INSPF-OTION � OperatIng Permit 2361 - UST FACILITY <br />vftv)*oon Roftepsetwk4am costicmadedonsooduilng.wpeaen <br />M <br />05! <br />101 <br />1-1802,5284 <br />No Ramt4 to operate <br />mV <br />PR b COS <br />102 <br />14SC 252"a)(3) <br />No written agreement betweentank owner and tank operator to monitor the tank system <br />o <br />o a COS <br />103 <br />HSC 2b282.2 <br />Current lingricial iWotialMlity documents not submitted <br />V <br />a R <br />1o4 <br />CCR 2711 \j <br />UST Opemtlng Permit Application for FoollIty, and Tank Infaffnallon not submitted or current <br />nV <br />o o COS <br />log <br />HSC =66(0) <br />Current DOE number not submitted <br />a V <br />a R a COS <br />lot <br />CCR2832 .-- "N <br />Monitoring and response plans not current or approved by the 5HB <br />v V <br />a R o 00 <br />. 107 <br />QPR2e32(d)(l)(o),4 <br />plot pla*%a map not submitted or fa%d to completely show whom Monitoring is performed <br />w V <br />o R o COS <br />108 <br />OCR 2637(9,263t1(e) <br />Failed to notify the EHD 48 hours prior to conducting jeallng <br />Q V <br />aft a 008 <br />09 <br />GOR 2031 <br />Folled to toot secondary conlalmenk <br />a V <br />. <br />aRP 008 <br />110 <br />CCR 2637(®) <br />Failed to oubrnk somdary containment test report within 30 days <br />a V <br />a R u COS <br />jil <br />CCR 2630(s) <br />Failed to toot monitoring and leak detection equipment annually <br />a V <br />a R 0 COS <br />112 <br />HSC 2112114.22112114.2 <br />Failed to last split cordalners annLmly <br />o <br />a R i3COS <br />113 <br />CCR 2630(d) <br />Failed to submit monitoring system cedlitceflon teat Mon within 30 days <br />a V <br />a R a Coll <br />114 <br />CCR 2830(o <br />Falled to perform 0.1 Uph ennuell line last for pressurized piping without (ah sale or shut down <br />p <br />n R a COS <br />-11-5 <br />CCR2715(8)Failed <br />to Inform the FHD of a change of designated operator within 30 d!,q% <br />93V <br />0 R 13 COS <br />17 <br />CCR 2716 — <br />De4nated operate; service tech at ftlaller did M pDaefts Otlyront ICG codification <br />-oV <br />a oCM <br />117 <br />HSC 26202.6 <br />Failed to conduct ELD testing on a system located within 10W of 0 PtIbI10 Well <br />OV <br />0 R 13 COS - <br />118 <br />- <br />HSC 26292.6 <br />Failed to repair andWest system due to failed ELD tog <br />0 V <br />43R 0 COS <br />jig <br />CCR 2644.1(a)(5) <br />Failed to submit FLO test results within 60 days <br />OV <br />PR 93 COS <br />120 <br />COR 2603 <br />Failed to inspect a lined or repaired steel tank within in years of lining and every 5 years after <br />a V <br />0 R ® COO <br />121 <br />COR 2803 <br />Failed to submit: tank lining certification within 30 days or to conduct proper tote <br />a V <br />a k a 008 <br />122 <br />MO 20299 <br />Documents were taislied or misrepresented <br />a V <br />a R a COS <br />123 <br />- <br />C;M 9631 <br />Permit to repair UST system not obtained <br />OV <br />ok U COS <br />124 <br />CCR 2636(d) <br />Failed to submit USTZerfificallon of installailDnNodificallon <br />0 V <br />a R 0 COB <br />125within <br />IC01127112(f) <br />galled to 6ubmit a wrlilonreWn00 ee days df reoblving an Inspection report <br />0 V <br />120 <br />1 HSC 2MQ4(e)(4) <br />.Palled to report program data ele0t(OnWY <br />sV <br />a R n COS <br />10 <br />201 <br />M <br />CCR J2(b) <br />action <br />Tailed to maintain elaffn logs and/or records <br />13V <br />c3R mCOG <br />GO <br />OR a <br />" ?r <br />ARTS VEL080, Spnlor AEH8 <br />(209) 4SM453 <br />ar <br />11/21/2014 <br />Padh 1 8* R <br />