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Nov. 14. 2018 4:30PM No. 2487 P. 6 <br /> San Joaquin County <br /> Environmental Health Department 1"'O V 15 2018 <br /> 1868 East Hazelton Avenue, Stockton,California 95205-6232 <br /> Telephone.(209)468-3420 Fart:(209)468-3433 Web;www.s! bgy.or tg� hd ENVIRONMENTAL <br /> Facility Name: Facility Address: Dote: <br /> LODI MEMORIAL HOSPITAL 975 S FAIRMONT AVE LODI November 09 2018 <br /> 2010 See below Unlisted General violation <br /> oY oR oCflS <br /> x,-...,tee'—i,�.^�c�rw��:::.a. �. °a.•����� _. � �� , <br /> Item# Remarks <br /> 111 CCR 2638(a)&(b),26410)Failed to test monitoring and leak detection equipment annually. <br /> Annual monitoring system certification was last performed on October 28, 2017. Verification of vacuum <br /> communication on all four pipes was completed today,on November 9,2018,one month past due. These tests are <br /> required once every 12 months. Take all necessary precautions to ensure testing is performed in a timely manner. <br /> This is a Class II violation. <br /> Overall Inspection Comments: <br /> NOTE: Testing conducted on October16, 2018 was Incomplete. Piping communication testing could not be <br /> conducted for all four pipes due to no test ports. This testing was conducted today. All EHD staff time <br /> associated with the reinspection will be billed at the current hourly rate ($152). This inspection report is an <br /> addendum to the report issued on October 16, 2018. <br /> Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br /> documenting the corrective actions that have been or will be taken for each violation, and any supporting <br /> paperwork, by November 15, 2018, <br /> Starting September 1, 2018,all in-office CERS help will be provided at EHD hourly rate($152). To schedule an <br /> appointment, please call (200)468-3420. <br /> Documents provided: Return to Compliance Certification form <br /> AFTER THE COMPLIANCE DATE, EMD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH FRINGING THIS <br /> FACILITY BACK INTO COMPLIANCE. <br /> THIS FACILITY 15 SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> Received by: Dale: November 09,2018 inspector: Inspector Phone: <br /> Printed Name and Title: STACY RIVERA,Senior RENS (209)4683440 <br /> L_(�0*4thrlch,Maintenance Manager <br /> FA0000513 PR0231331 SC333 11109/2018 <br /> EHD 23-01 Rev.00122Ha page 4 of 4 UrAeraround Storage Tank Program OIR <br />