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S A N J 0 A Q I I I Irl Environmental Health Department <br /> CCUN r <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Fe:LODI MEMORIAL HOSPITAL 975 S FAIRMONT AVE, LODI ptember 18, 2023 <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 /> 104 CCR 2632(d)(1), 2634(d)Failure to submit a complete and accurate UST Monitoring Plan. <br /> OBSERVATION: The monitoring plan is not current. The people listed as having responsibility(Tim Duncan &Jim <br /> McCarthy)are no longer with Lodi Memorial Hospital. <br /> REGULATION GUIDANCE: The monitoring plan must be uploaded to the California Environmental Reporting <br /> System (CERS). <br /> CORRECTIVE ACTION: Immediately log into CERS, make the necessary changes, and submit for review by the <br /> EHD. <br /> This is a repeat violation, Class ll. <br /> 105 CCR 2632(d)(2), 2634(e)Failure to submit a complete and accurate UST Response Plan. <br /> OBSERVATION: The response plan is not current. The responsible persons listed in section IV(Tim Duncan &Jim <br /> McCarthy)are no longer with Lodi Memorial Hospital. <br /> REGULATION GUIDANCE: The response plan must be uploaded to the California Environmental Reporting System <br /> (CERS). <br /> CORRECTIVE ACTION: Immediately log into CERS, upload the completed form, and submit for review by the EHD. <br /> This is a repeat violation, Class II. <br /> 107 HSC 25292.2; CCR 2711(a)(11)Failure to submit and maintain complete and current financial responsibility <br /> documents. <br /> OBSERVATION: Updated financial responsibility documents have not been submitted to the EHD. The most recent <br /> certificate of financial responsibility in CERS is dated 10/19/2020 and the most recent letter of chief financial officer <br /> is dated 10/27/2020. <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/, upload the required documents, and maintain a copy on site. <br /> This is a repeat violation, Class ll. <br /> FA0000513 PR0231331 SCO01 09/18/2023 <br /> EHD 23-01 Rev.12/06/2021 Page 4 of 6 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 />