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S0 JOA U 1 Environmental Health Department <br /> u ;N i YI AMENDED <br /> 1/4/2021 <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> LODI MEMORIAL HOSPITAL 975 S FAIRMONT AVE, LODI October 28, 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 /> 107 HSC 25292.2; CCR 2711(a)(11)Failure to submit and maintain complete and current financial responsibility <br /> documents. <br /> OBSERVATION: Financial responsibility documents have not been submitted to the EHD. The most recent <br /> financial responsibility documents in CERS are dated: <br /> -CFO Letter 10/18/2019 <br /> -Certificate of Financial Responsibility 10/21/2019 <br /> REGULATION GUIDANCE: Current financial responsibility documents are required to be submitted annually. <br /> CORRECTIVE ACTION: Immediately log into the California Environmental Reporting System (CERS)at <br /> http://cers.calepa.ca.gov/, and upload the required documents. <br /> This is a minor violation. <br /> 203 CCR 2712(b)(1-2)Failure to maintain monitoring records for 36 months and maintenance records for 60 months. <br /> OBSERVATION: Maintenance and monitoring records for the last three years were not found on site. <br /> -Work order for vac sensor(VR 463)replacement on 2/5/2020 was not found on site. <br /> REGULATION GUIDANCE: These records shall be maintained on site for at least three years. Monitoring records <br /> include: (1)date and time of all monitoring or sampling; (2)monitoring equipment calibration and maintenance <br /> records; (3)results of any visual observations; (4)results of sample analysis performed a lab or in the field; (5)logs <br /> of all readings of gauges or other monitoring equipment, ground water elevations, or other test results; (6)results of <br /> inventory readings and reconciliations. <br /> CORRECTIVE ACTION: Immediately locate and maintain all missing maintenance and monitoring records for the <br /> last three years on site and submit copies to the EHD. <br /> This is a repeat violation, Class Il. <br /> 208 CCR 2716(a-e) Failure to comply with the designated operator inspection requirements. <br /> OBSERVATION: The designated operator failed to check and note the correct test date for the 2019 Monitoring <br /> System Certification on the 10/7/2020 designated operator inspection report.The listed 2019 Monitoring System <br /> Certification was conducted on 9/22/2019 but it was conducted on 10/22/2019. <br /> REGULATION GUIDANCE: During the inspection, the designated operator shall check that all required testing and <br /> maintenance for the UST system have been completed and document the dates they were done. <br /> CORRECTIVE ACTION: Ensure that designated operators performing inspections at this facility are including all of <br /> the required information on the reports. <br /> This is a repeat violation, Class ll. <br /> Overall Inspection Comments: <br /> FA0000513 PR0231331 SCO01 10/28/2020 <br /> EHD 23-01 Rev.9/16/2020 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.sjgov.org/EHD <br />