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San Joaquin County Environmental Health Department 1868 East Hazelton Avenue, Stockton, California 95205-6232 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.oWL hd Underground Storage Tank Program Inspection Report Facility Name: Facility Address: Date: LODI MEMORIAL HOSPITAL 1 975 S FAIRMONT AVE, LODI October 09, 2014 UST System Observations 322 CCR 2636(f)(2) Line leak detector not installed ❑V ❑R ❑COS 323 CCR 2636(f)(2) Leak detector failed to detect a 3.0 gph leak at 10 psi ❑V ❑R ❑COS 324 CCR 2635(b) No spill bucket installed or failed to provide a means to keep it empty ❑V ❑R ❑COS 325 CCR 2635(b) Spill container failed to contain a minimum capacity of five gallons ❑V ❑R ❑COS 326 j CCR 2635(b)(2) Overfill prevention system not present,was overridden,or failed to meet overfill requirements ❑V ❑R ❑COS 327 HSC 25283.5 Unburied below grade UST failed to meet exemption status ❑V ❑R ❑COS 328 CCR 2717.1(g) Tampered with red tag ❑V ❑R ❑COS 329 CCR 2717.1(f) Deposited petroleum into a red tagged UST ❑V ❑R ❑COS 330 HSC 25299(f)(2) Tampered with or disabled leak detection devices or alarms ❑V ❑R ❑COS 331 CCR 2631.1 UST system not compatible with the substance stored ❑V ❑R ❑COS 332 HSC 25298(b) Failed to comply with temporary closure requirements ❑V ❑R ❑COS 333 HSC 25298(c) Failed to comply with permanent closure requirements ❑V ❑R ❑COS Non-Pressurized Piping 401 CCR 2636(a)(3) Suction piping not properly sloped or incorrectly located check valve ❑V ❑R ❑COS 402 CCR 2643(d) Daily monitoring of suction pipe(pre-Jan 1984)not performed ❑V ❑R ❑COS 403 CCR 2643(d) Triennial 0.1 gph line test for conventional suction piping not performed(pre-January 1984) ❑V ❑R ❑COS 404 CCR 2643(e) Biennial 0.1 gph test for gravity piping not performed(pre-January 1984) ❑V ❑R ❑COS Other Violations 2010 See below Unlisted Administration/Documentation violation ❑V ❑R ❑COS 2030 See below Unlisted Operations/Maintenance violation ❑V ❑R ❑COS 2060 See below Unlisted Design/Construction violation ❑V ❑R ❑COS SUMMARY OF VIOLATIONS (CLASS I,CLASS II,or MINOR-Notice to Comply) Item# Remarks 103 HSC 25292.2 Current financial responsibility documents not submitted. Financial responsibility documents have not been submitted to the EHD. Current financial responsibility documents are required to be submitted annually. Immediately log into the California Environmental Reporting System (CERS) at http://cers.calepa.ca.gov/, upload the required documents. A copy of the current document has been provided on site; therefore, the violation has been corrected on site. This is a minor violation. Overall Inspection Comments: Consent to perform the inspection, take photos and collect samples was given by Randy Roehrich, Maintenance Supervisor . This facility's designated operator is Randy Roehlich (ICC 5242367 expiration date: 7/15/16) . The service technician was Felix Ramirez (ICC 5273934 expiration date: 12/6/14, and CA UST Tank Tester#08-1740 expiration date: 5/31/17), who had the following manufacturer's certifications: Veeder Root 834976 expiration date: 7/8/16, and Petro Tite 3000032620 expiration date: 8/7/15. Receiv (i aq: Inspector: Phone: Date: JEFFREY WONG, Senior REHS (209)468-0335 10/09/2014 Page 3 of 4