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SAN JOAQUIN Environmental Health Department COU CITY �v FEl [reotne&s qrows Frere, Underground Storage Tank Program Inspection Report Facility Name: Facility Phone: Date: Sutter Valley Hospitals dba Sutter Tracy Community Hospital (209)832-6032 November 13, 2023 Facility Address: CERS ID: 1420 N Tracy Blvd,Tracy, CA 95376 10397599 Inspection Contact: Title: Phone: Jason Simmons Environmental Contact (209)832-6032 Inspection Type: Program: ROUTINE INSPECTION-Operating Permit 12361 - UST FACILITY Consent For: Consent Given By: ❑x Inspection ❑x Photos ❑ Samples Jason Simmons, Operation Manager Service Technician Onsite: Exp.Date: Designated Operator: Exp.Date: Isaac Anderson 09/10/2024 Isaac Anderson 08/12/2025 Service Technician Manufacturer's Training: VR, 08/29/24; OPW,06/22/04 CCR=Title 23 California Code of Regulations HSC=Health and Safety Code CFR=Code of Federal Regulations EHD=Environmental Health Department V=Violation R=Repeat violation COS=Corrected on site during inspection File Review 101 HSC 25284;CCR Failure to obtain a permit to operate from the EHD including but not limited to unpaid permit fees D V DR D COS 2711(d) 102 CCR 2711 Failure to submit a complete and accurate application for a permit to operate a UST D V DR D COS 103 CCR 2635(f),2636(c)(2) Failure to submit the UST Certification of Installation/Modification D V D R D COS 104 CCR 2632(d)(1), Failure to submit a complete and accurate UST Monitoring Plan D V DR D COS 2634(d) 105 CCR 2632(d)(2), Failure to submit a complete and accurate UST Response Plan D V DR D COS 2634(e) 106 CCR 2632(d),2641(h) Failure to submit and maintain a current facility plot plan/site map D V DR D COS 107 HSC 25292.2;CCR Failure to submit and maintain complete and current financial responsibility documents ■V DR D COS 2711(a)(11) 108 CCR 2620(b);HSC Failure to implement or maintain a written agreement between the UST owner and operator D V DR D COS 25284(a)(3) 109 CCR 2715(a)(1)(B), Failure to submit"Designated Underground Storage Tank Operator Identification Form"within 30 days D V DR D COS 2715(a)(3) 110 CCR 2715(a)(1)(A), Failure to submit the"Underground Storage Tank Statement of Understanding and Compliance Form" D V DR D COS 2715(a)(2) 111 CCR 2637,2638(e), Failed to notify the EHD 48 hours prior to conducting testing D V DR D COS 2643(g) 112 CCR 2638,26410), Failure to have properly qualified service technician test leak detection equipment every 12 months D V DR D COS 2715(f) 113 CCR 2637(a-d),2712(b) Failure to conduct secondary containment testing D V DR D COS (1)(F) 114 CCR 2636(f)(3),2643(c) Failure to perform line integrity test every 12 months or within 30 days of repair of primary pipe D V DR D COS (3) 115 CCR 2638(c),2638(d) Failure to submit"Monitoring System Certification Form"within 30 days of completion of the test D V DR D COS 116 CCR 2637.1(d), Failure to submit the"Spill Container Testing Report Form"within 30 days D V DR D COS 2637.1(a) 117 CCR 2637(e),2637(f) Failed to submit"Secondary Containment Testing Report Form"within 30 days after the test D V D R D COS 118 CCR 2637.2(d&e), Failure to submit the"Overfill Prevention Equipment Inspection Report Form"within 30 days D V DR D COS 2665(a&b) 119 CCR 2663, 2712(b)(6) Failure to comply with tank lining certification,testing,inspection,and record requirements D V DR D COS 120 CCR 2631,2640.1, Failure to submit and/or maintain documentation regarding compatibility for UST system components D V DR D COS 2665,2711 FA0002562 PR0231736 SCO01 11/13/2023 EHD 23-01 Rev.12/06/2021 Page 1 of 5 Underground Storage Tank Program OIR 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD