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SAN -JO QUI N --COU NTY �r =x . Greatness gtows here - Environmental Health Department Underground Storage Tank Program Inspection Report Facility Name: Facility Phone: DAMERON HOSPITAL (209) 944-5550 Date: February 07, 2020 Facility Address: 525 W ACACIA ST, STOCKTON, CA 95203 CERS ID: 10181003 Inspection Contact: Nicholas Chambers Title: Maintenance Manager Phone: (209) 461-3157 Inspection Type: ROUTINE INSPECTION - Operating Permit Program: 12361 - UST FACILITY Consent For: 0 Inspection 0 Photos 0 Sample I Consent Given By: I Nicholas Chanbers, Maintenance Manager Service Technician Onsite: Exp. Date: Felix Ramirez 11/07/2020 Designated Operator: Exp. Date: Zane Nimmo 02/25/2020 Service Technician Manufacturer's Training VMI, 11/12/21; OPW, 11/27/20; VR, 07/07/20 CCR = Title 23 California Code of Regulations HSC = Health and Safety Code CFR = Code of Federal Regulations V = Violation R = Repeat violation COS = Corrected on site during inspection File Review 101 HSC 25284; CCR 2711(d) Failed to obtain a permit to operate from the EHD including but not limited to unpaid permit fees ❑ V ❑ R ❑ COS 102 HSC 25284(a)(3)(A)/(B) No written agreement between tank owner and tank operator to monitor the tank system ❑ V ❑ R ❑ COS 103 HSC 25292.2, 25299.30 Failure to submit and maintain complete and current financial responsibility documents ■ V ■ R ❑ COS 104 CCR 2711 UST operating permit application for facility and tank information not submitted or current ❑ V ❑ R ❑ COS 105 CCR 2632(d)(1), 2634(d) Failed to have an approved UST monitoring plan ❑ V ❑ R ❑ COS 106 CCR 2632(d)(2), 2634(e) Failed to have an approved UST response plan ❑ V ❑ R ❑ COS 107 CCR 2632(d), 2641(h), 2711(a) Plot plan/site map not submitted or failed to completely show where monitoring is performed ❑ V ❑ R ❑ COS 108 CCR 2637, 2638(e), 2643(g) Failed to notify the EHD 48 hours prior to conducting testing ❑ V ❑ R ❑ COS 109 CCR 2637(a -d), 2712 Failed to test secondary containment, or failed to maintain test records for 36 months ❑ V ❑ R ❑ COS 110 CCR 2637(e), 2637(f) Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test ❑ V ❑ R ❑ COS 111 CCR 2638, 2641 Q), 2715(f) Failed to test monitoring and leak detection equipment every 12 months ❑ V ❑ R ❑ COS 112 HSC 25293 Failure to maintain UST records to enable the UPA to determine whether the UST is in compliance ❑ V ❑ R ❑ COS 113 CCR 2638(c), 2638(d) Failure to submit "Monitoring System Certification Form" within 30 days of completion of the test ❑ V ❑ R ❑ COS 114 CCR 2636(f)(3), 2643(c) (3) No 0.1 gph annual line integrity test for pressurized piping, or within 30 days after repair ❑ V ❑ R ❑ COS 115 CCR 2715(a)(1)(B), 2715(a)(3) "Designated Underground Storage Tank Operator Identification Form" not submitted within 30 days ❑ V ❑ R ❑ COS 116 CCR 2715 Designated operator, service tech or installer did not possess current ICC certification ❑ V ❑ R ❑ COS 117 CCR 2663, 2712(b)(6) Failure to comply with tank lining, recordkeeping, and inspection requirements ❑ V ❑ R ❑ COS 118 CCR 2715(a)(1)(A), 2715(a)(2) Failure to submit the "Underground Storage Tank Statement of Understanding and ComplianceForm" ■ V ❑ R ❑ COS 119 HSC 25299(a)(8), 25299(b)(7) Documents were falsified or misrepresented ❑ V ❑ R ❑ COS 120 CCR 2635(d) Failed to submit UST Certification of Installation/Modification ❑ V ❑ R ❑ COS 121 CCR 2712(f) Failure to implement corrections and submit written response within 30 days of receiving the report ■ V ❑ R ❑ COS FA0002864 PR0231002 SCO01 02/07/2020 EHD 23-01 Rev. 9/20/2019 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.sjcehd.com