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Hazardous Materials Program Inspection Report <br /> Facility Name: <br /> JACK IN THE BOX #4370 <br /> Facility Address: <br /> 733 W CHARTER WAY, STOCKTON, CA 95206 <br /> Facility Phone: <br /> (209) 465-2682 <br /> Program: <br /> 1919 - HMBP-CO2 Only Food Facility <br /> Inspection Type: <br /> ROUTINE INSPECTION - Operating Permit <br /> Date: <br /> December 08, 2016 <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br /> CERS ID: <br /> 10180969 <br /> Inspection Contact: <br /> Marcela Rogue <br /> Consent For: Consent Given By: <br /> Marcela Rogue, manager <br /> Title: <br /> manager <br /> Phone: <br /> (209) 465-2682 <br />T Inspection £ Photos £ Samples <br />R = Repeat violation COS = Corrected on site during inspectionV = Violation <br />CCR = California Code of Regulations HSC = Health and Safety Code CFR = Code of Federal Regulations <br />Violations <br /> 1 □ V □ R □ COSFailed to pay annual operating feesSJO 4432 <br /> 2 ■ V □ R □ COSFailed to complete and electronically submit a hazardous materials business planHSC 25505, 25508(a) <br />(1) <br /> 3 □ V □ R □ COSFailed to establish and implement a hazardous materials business planHSC 25507 <br /> 4 □ V □ R □ COSFailed to complete and/or submit the Business Activities or Owner/Operator Identification pageHSC 25508(a)(1) <br /> 5 □ V □ R □ COSFailed to complete and/or submit hazardous materials inventory for all reportable materials on siteHSC 25506(a) <br /> 6 ■ V □ R □ COSFailed to complete and/or submit a site map with all required contentHSC 25505(a)(2) <br /> 7 □ V □ R □ COSFailed to establish and/or submit emergency response procedures for a release or threatened releaseHSC 25505(a)(3) <br /> 8 □ V □ R □ COSFailed to submit a training program or program is not reasonable or adequate for facilityHSC 25505(a)(4) <br /> 9 □ V □ R □ COSFailed to annually review and certify that the business plan is complete, accurate, and up to dateHSC 25508.2 <br /> 10 □ V □ R □ COSFailed to submit revisions to business plan within 30 days of substantial change in operationsHSC 25508.1(a)-(f) <br /> 11 □ V □ R □ COSFailed to provide or document initial and/or refresher training to appropriate personnelHSC 25505(a)(4) <br /> 12 □ V □ R □ COSFailed to have the business plan readily available to facility or EHD personnelHSC 25505(c) <br /> 13 □ V □ R □ COSFailed to notify property owner that facility is subject to and in compliance with the HMBP programHSC 25505.1 <br /> 14 □ V □ R □ COSFailed to report actual or threatened release to the EHD and/or CalOES Warning CenterHSC 25510 <br /> 15 □ V □ R □ COSFailed to submit emergency response plan when not meeting Ag handler exemption requirementsHSC 25507.1 <br /> 16 □ V □ R □ COSFailed to submit training program when not meeting Ag handler exemption requirementsHSC 25507.1 <br /> 17 □ V □ R □ COSFailed to establish and implement a HMBP when not meeting remote unstaffed facility exemptionsHSC 25507.2 <br /> 18 □ V □ R □ COSFailed to submit a written response within 30 days of receiving an inspection reportHSC 25511 <br /> 1010 □ V □ R □ COSUnlisted Administration/Documentation violation See below <br /> 1040 □ V □ R □ COSUnlisted Release/Leaks/Spills violation See below <br />SUMMARY OF VIOLATIONS <br />(CLASS I, CLASS II, or MINOR - Notice to Comply) <br />RemarksItem # <br />Page 1 of 2 <br />FA0002577 PR0526525 SC001 12/08/2016 <br />EHD 19-01 Rev. 09/22/16 Hazardous Materials Program OIR