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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.org/ehd Underground Storage Tank Program Inspection Report Facility Name: Facility Phone: Date: LODI MEMORIAL HOSPITAL (209) 334-3411 October 06, 2016 Facility Address: CERS ID: 975 S FAIRMONT AVE, LODI, CA 95240 10180611 Inspection Contact: Title: Phone: Randy Roehrich Plant Maintenance Sup (209) 339-7667 Inspection Type: Program: ROUTINE INSPECTION -Operating Permit 2351 - UST FACILITY-2481 COMPLIANT Consent For: I Consent Given By: 0 Inspection 0 Photos I] Sample Randy Roehrich, Plant Maintenance Supervisor Service Technician Onsite: Exp.Date: Designated Operator: Exp.Date: Zane Nimmo 06/19/2017 Randy Roehrich 07/16/2018 Service Technician Manufacturer's Training: Tank Tester, 11/10/16; VR, 09/27/17; Petro Line Tester, 02/04/18 CCR=California Codeo egu ations HSC=Health and Safety Code CFR=Code of a era Regulations V=Violation R=Repeat violation COS=Corrected on site during inspection File Revievr 101 HSC 25284 No permit to operate ❑V ❑R ❑COS 102 HSC 25284(a)(3) No written agreement between tank owner and tank operator to monitor the tank system ❑V ❑R ❑COS 103 HSC 25292.2 Current financial responsibility documents not submitted ■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) Failed to have an approved UST monitoring plan ❑V ❑R ❑COS 106 CCR 2632(d)(2) Failed to have an approved UST response plan ❑V ❑R ❑COS 107 CCR 2632(d)(1)(C) Plot plan/site map not submitted or failed to completely show where monitoring is performed ❑V ❑R ❑COS 108 CCR 2637(f),2638(e) Failed to notify the EHD 48 hours prior to conducting testing ❑V ❑R ❑COS 109 CCR 2637 Failed to test secondary containment ❑V ❑R ❑COS 110 CCR 2637(e) Failed to submit secondary containment test report within 30 days ❑V ❑R ❑COS 111 CCR 2638(a) Failed to test monitoring and leak detection equipment annually ❑V ❑R ❑COS 112 HSC 25284.2 Failed to test spill containers annually ❑V ❑R ❑COS 113 CCR 2638(d) Failed to submit monitoring system certification test report within 30 days ❑V ❑R ❑COS 114 CCR 2636(f) Failed to perform 0.1 gph annual line test for pressurized piping without fail safe or shut down ❑V ❑R ❑COS 115 CCR 2715(a) Failed to inform the EHD of designated operator identification or change 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 Failed to inspect a lined or repaired steel tank within 10 years of lining and every 5 years after ❑V ❑R ❑COS 118 CCR 2663 Failed to submit tank lining certification within 30 days or to conduct proper tests ❑V ❑R ❑COS 119 HSC 25299 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) Failed to submit a written response within 30 days of receiving an inspection report ❑V ❑R ❑COS 122 CCR 26310) Failure to submit UST system component statement of compatibility for substance stored ❑V ❑R ❑COS Orr Sites,Records 201 CCR 2712(b) Failed to maintain alarm logs and/or records of follow up actions ❑V ❑R ❑COS 202 CCR 2712(b) Failed to maintain cathodic protection test records on site for at least 6 1/2 years ❑V ❑R ❑COS 203 CCR 2712(b) Failed to maintain records of monitoring, repair,lining,and upgrades on site ❑V ❑R ❑COS FA0000513 PR0231331 SCO01 10/06/2016 EHD 23-01 Rev.09/22/16 Page 1 of 4 Underground Storage Tank Program OIR