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SAN J O A R N Environmental Health Department <br /> ,_ -:JUIN i y �V <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> KAISER PERMANENTE 7373 WEST LN, STOCKTON June 25, 2020 <br /> Other Violations <br /> 2010 See below Unlisted General violation ❑V ❑R ❑COS <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> Item# Remarks <br /> 113 CCR 2638(c), 2638(d) Failure to submit"Monitoring System Certification Form"within 30 days of completion of the <br /> test. <br /> OBSERVATION:Annual monitoring system certification and leak detector testing was performed on 6/6/2019 and a <br /> test report was submitted on 7/12/2019, 36 days late. <br /> REGULATION GUIDANCE:A copy of the test report must be submitted within 30 days of the tests. <br /> CORRECTIVE ACTION: Take all necessary precautions to ensure testing and submittal of test reports are <br /> performed in a timely manner. <br /> This is a minor violation. <br /> 123 CCR 2637.1(d), 2637.1(e)Failure to submit the"Spill Container Testing Report Form"within 30 days after the test. <br /> OBSERVATION:Annual spill container testing was performed on 6/6/2019 and a test report was submitted on <br /> 7/12/2019, 36 days late. <br /> REGULATION GUIDANCE:A copy of the test report must be submitted within 30 days of the tests. <br /> CORRECTIVE ACTION: Take all necessary precautions to ensure testing and submittal of test reports are <br /> performed in a timely manner. <br /> This is a minor violation. <br /> Overall Inspection Comments: <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 7/25/2020 . <br /> To minimize person to person contact EHD is choosing to write the name of person receiving the report instead <br /> of having them sign. Starting September 1, 2018, all in-office CERS help will be provided at EHD hourly rate <br /> ($152). To schedule an appointment, please call (209)468-3420. <br /> Documents provided during inspection: <br /> -EHD class schedule <br /> -Return to compliance certification form <br /> -Corrective Action Statement <br /> FA0002602 PR0232494 SCO01 06/25/2020 <br /> EHD 23-01 Rev.9/20/2019 Page 4 of 5 Underground Storage Tank Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />