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A NJ O A Q U l N Environmental Health Department <br /> COUNTY— <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Fe:LODI MEMORIAL HOSPITAL 975 S FAIRMONT AVE, LODI ptember 20, 2022 <br /> Single-Walled Non-Pressurized Piping <br /> 404 CCR 2643(e),2661(f) Failure to conduct 0.1 gph test on single-walled gravity piping biennially or post repair(pre-1984) ❑V ❑R ❑COS <br /> Other Violations <br /> 2010 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 /> 107 HSC 25292.2; CCR 2711(a)(11)Failure to submit and maintain complete and current financial responsibility <br /> documents. <br /> OBSERVATION: Financial responsibility documents have not been submitted to the EHD. The most recent <br /> financial responsibility documents in CERS are dated 10/20/20 <br /> REGULATION GUIDANCE: Current financial responsibility documents are required to be submitted annually. <br /> CORRECTIVE ACTION: Immediately log into the California Environmental Reporting System (CERS)at <br /> http://cers.calepa.ca.gov/, and upload the required documents. <br /> This is a minor violation. <br /> 208 CCR 2716(a-e) Failure to comply with the designated operator inspection requirements. <br /> OBSERVATION: Designated operator reports were not signed within the required time frame. <br /> -The 9/15/2022 designated operator report was not signed by the owner/operator for both tanks on site. <br /> REGULATORY GUIDANCE:Within 48 hours of the completion of the designated UST operator visual inspection, <br /> the designated operator shall sign and provide the owner or operator with a copy of the inspection report. Within 72 <br /> hours of being provided a signed copy of the report,the owner or operator shall provide a description of each <br /> corrective action taken or to be taken and shall sign and date the report, acknowledging the identified compliance <br /> issues. <br /> CORRECTIVE ACTION: Ensure all designated operator inspection reports are completed and signed within the <br /> required time frame in the future. <br /> This is a repeat violation, Class II. <br /> 301 HSC 25292.1(a)Failure to operate UST system to prevent unauthorized releases including leaks, spills and overfills. <br /> OBSERVATION: 304 sensor in the tank fill sump was non operational during the monitoring certification. <br /> REGULATION GUIDANCE: The underground storage tank system shall be operated to prevent unauthorized <br /> releases, including spills and overfills. <br /> This was corrected on site. <br /> This is a Class II violation. <br /> FA0000513 PR0231331 SCO01 09/20/2022 <br /> EHD 23-01 Rev.12/06/2021 Page 4 of 5 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.sjgov.org/EHD <br />