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0 6 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, California 95205-6232 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sagov.org/ehd UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT Facility p Address: 945 S. Fairmont, Lodi Inspection Oct 10, 2012 Lodi Memorial Hospital Date: Facility Title: Phone Contact: Rany Roehrich Maintenance Supervisor 339-7667 Inspection )3 Type: Routine 'r3(Monitoring System Certification ❑ ❑ Installation Complaint—ID#: ❑Other: (Authority HSC 25289) RRoehrich Maintenance Superviso Consent for: ;Inspection ❑ any Title:Sampling Photos Granted by: Monitoring VR TLS350 & EBW � Piping System: ❑Pressurized 11 Suction 11 Gravity Gravity Overfill Panel: System: F1 Mechanical 11Audible/visual UST 3 4 ---Product--- -----DSL DSL----- ------------- -------------- ------------- --------------------------- ------------- ------------- Designated Date: Rany Roehrich5242367 Dat e:Exp Operator: ' 7/18/14 Violations: :1M1-Release Detection 11M2-Release Prevention OM3—Both On Site Service ICC Exp Manufacturer's Technician: FelixRamirez5273934 Date: 12/11/2012 Training: VR 634976 6/26/14; Pupora Line 5/3/13 VIOLATIONS # C1 C2 M Code Section HSC=California Health and Safety Code;CCR=California Code of Regulations C1=Class 1 violation;C2=Class 2 violation;M=Minor violation 111 MINOR@! 111 101 HSC 25284 No permit to operate 102 HSC 25404.5 Annual operating fees not paid 103 HSC 25284(a)(3) No written agreement between the person that the operating permit was issued to and the tank operator to monitor the tanks stem 104 HSC 25292.2 Current financial responsibility documents not on file with the Environmental Health Department(EHD) 105 CCR 2711 Current Unified Program Consolidated Forms not on file with the EHD(Facility and tank form) 106 CCR 2632(b) Monitoring Program(Monitoring&Response Plans)is not current or approved by the EHD 107 CCR 2632(d)(1)(C) Plot plan/site map not submitted or fails to completely show where monitoring is performed 108 CCR 2637 Secondary containment:(a)test not performed;(e)test report not submitted within 30 days;(f)test notification not provided to the EHD at least 48 hours prior to conducting the test Monitoring equipment certification:(a)not performed annually;(d)test report not submitted within 30 days; 109 CCR 2638 (e)test notification not provided to the EHD at least 48 hours prior to conducting an installation,repair, replacement,calibration,or certification 110 HSC 25291(0 Annual line leak detector test not performed (M1) 111 HSC 25284.2 Annual spill containment testing not performed 112 CCR 2636(f)(4) Annual line tightness test not performed if positive shutdown or fail safe not present (M1) 113 CCR 2715(a) Failed to inform the EHD of a change of designated operator within 30 days 114 CCR 2715(b) Designated operator does not possess a current ICC CA UST System Operator certification 115 CCR 2660(k) Repair for tank or piping not tested for tightness after completion of the repair pursuant to (M2) permit conditions 116 HSC 25292.5 Enhanced leak detection(ELD)testing not performed on a system located within 1000'of public well,or failures not repaired and retested 117 CCR 2661 Permit to repair UST system not obtained 118 HSC 25286(a) Operational permit not amended when UST storage and/or monitoring system changed 119 HSC 25298(b) Permit to temporarily close UST system not obtained 120 HSC 25298(c) Permit to close UST system not obtained Maintenance&monitoring records not maintained 3 years,cathodic protection records for 6'/2 years,written performance claims pertaining to release detection systems for 5 years,or records of repairs,linings,and 201 CCR 2712(b) upgrades for the life of the tank. Monitoring records include:(1)date and time of all monitoring or sampling; (2)monitoring equipment calibration and maintenance records;(3)results of any visual observations;(4) results of sample analysis performed a lab or in the field;(5)logs of all readings of gauges or other monitoring equipment, round water elevations,or other test results; 6 results of inventory readings and reconciliations 202 CCR 2712(i) Monitoring plan,response plan,and/or operating permit and all conditions not onsite Unauthorized release that:(c)did not escape secondary containment and cleaned up within eight hours (M1) 203 CCR 2650 was not recorded;(e)escaped secondary containment, of cleaned up after eight hours,or a sudden loss of product was not reported to the EHD within 24 hours Inspector R eived By: Title: Jeffrey Wong (209) 468-0335 :7 EHD 23-02 Rev 04/19/12 P UST INSPECTION REPORT