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S A N A O A Q O I N Environmental Health Department <br /> -- _COUNTY <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: 711 <br /> ate: <br /> Sutter Valley Hospitals dba Sutter Tracy1420 N Tracy Blvd, Tracy ovember 17, 2017 <br /> reports, monitoring plans, monitoring system certification testing reports, secondary containment testing reports, <br /> operating permit, response plan, and daily alarm log. <br /> Documents Received: Return to Compliance Certification Form <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 /> AFTER THE COMPLIANCE DATE,EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING <br /> THIS FACILITY BACK INTO COMPLIANCE. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> Received by: Date: November 17, 2017 Inspector: Inspector Phone: <br /> Printed Name and Title: BETTY HO, EH Specialist (209)468-3455 <br /> Bernard Bourque, Safety Officer <br /> FA0002562 PR0231736 SCO01 11/17/2017 <br /> EHD 23-01 Rev.09/22/16 Page 5 of 5 Underground Storage Tank Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />