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S A J OAQ U I Environmental Health Department <br /> �. 0U N TY— <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> KAISER FOUNDATION- MANTECA 1777 W YOSEMITE AVE, MANTECA June 25, 2020 <br /> Other Violations <br /> 2010 1 See below Unlisted General violation ❑V ❑R ❑COS <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> Item# Remarks <br /> 110 CCR 2637(e), 2637(f) Failed to submit"Secondary Containment Testing Report Form"within 30 days after the test. <br /> OBSERVATION: Secondary containment testing was performed on 4/24/2019 and a test report was submitted on <br /> 3/25/2020, ten months late. <br /> REGULATION GUIDANCE: A copy of the test report must be submitted within 30 days of the tests. <br /> CORRECTIVE ACTION: Take all necessary precautions to ensure testing and submittal of test reports are <br /> performed in a timely manner. <br /> This is a minor violation. <br /> Overall Inspection Comments: <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 July 25, 2020 . <br /> To minimize person to person contact EHD is choosing to write the name of person receiving the report instead <br /> of having them sign. <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 (209) 468-3420. <br /> Documents provided: Return to compliance certification form and corrective action statement form. <br /> AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING <br /> THIS FACILITY BACK INTO COMPLIANCE. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> Received by: <br /> Date: June 25, 2020 Inspector: Inspector Phone: <br /> Printed Name and Title: PAUL NSO, EHS Trainee (209)468-3432 <br /> Gabriel Martin, Manager <br /> FA0003978 PR0232397 SCO01 06/25/2020 <br /> EHD 23-01 Rev.9/20/2019 Page 4 of 4 Underground Storage Tank Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />