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CALIFORNIA ENVIRONMENTAL REPORTING SYSTEM(CERS) <br /> CONSOLIDATED EMERGENCY RESPONSE / CONTINGENCY PLAN <br /> Prior to completing this Plan,please refer to the INSTRUCTIONS FOR COMPLETING A CONSOLIDATED CONTINGENCY PLAN <br /> A. FACILITY IDENTIFICATION AND OPERATIONS OVERVIEW <br /> FACILITY ID flCERS ID ^� DATE OF PLAN PREPARATION/REVISION A]_ <br /> FA0002192 10629325 9/23/2015 <br /> BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. <br /> Jack In The Box#565 <br /> BUSINESS SITE ADDRESS 103, <br /> 3506 W Hammer Lane <br /> BUSINESS SITE CITY IM- ZIP CODE 105. <br /> Stockton CA 95219 <br /> TYPE OF BUSINESS(e.g.,Painting Contractor) AS I INCIDENTAL OPERATIONS(e.g.,Fleet Maintenance) A4 <br /> Food Facility <br /> THIS PLAN COVERS CHEMICAL SPILLS,FIRES,AND EARTHQUAKES INVOLVING: (Check all that apply) A3_ <br /> ® 1.HAZARDOUS MATERIALS; ❑ 2.HAZARDOUS WASTES <br /> B. INTERNAL RESPONSE <br /> INTERNAL FACILITY EMERGENCY RESPONSE WILL OCCUR VIA*(Check all that apply) <br /> ® I.CALLING PUBLIC EMERGENCY RESPONDERS(i.e.,9-1-1) <br /> ❑2.CALLING HAZARDOUS WASTE CONTRACTOR <br /> ❑3.ACTIVATING IN-HOUSE EMERGENCY RESPONSE TEAM <br /> C. EMERGENCY COMMUNICATIONS,PHONE NUMBERS AND NOTIFICATIONS <br /> Whenever there is an imminent or actual emergency situation such as an explosion, fire, or release, the Emergency Coordinator(or his/ber designee when the <br /> Emergency Coordinator is on call)shall: <br /> 1. Activate internal facility alarms or communications systems,where applicable,to notify all facility personnel. <br /> 2. Notify appropriate local authorities(i.e,call 9-1-1). <br /> 3. Notify the California Emergency Management Agency at(800)852-7550. <br /> Before facility operations are resumed in areas of the facility affected by the incident,the emergency coordinator shall notify the California Department of Toxic <br /> Substances Control(DTSC),the local Unified Program Agency(UPA),and the local fire department's hazardous materials program that the facility is in compliance <br /> with requirements to: <br /> 1. Provide for proper storage and disposal of recovered waste,contaminated soil or surface water,or any other material that results from an explosion,fire,or release at <br /> the Facility;and <br /> 2. Ensure that no material that is incompatible with the released material is transferred,stored,or disposed of in areas of the facility affected by the incident until <br /> cleanup procedures are completed. <br /> INTERNAL FACILITY EMERGENCY COMMUNICATIONS OR ALARM NOTIFICATION WILL OCCUR VIA:(Check all that apply) CI. <br /> ® I.VERBAL WARNINGS; ❑2.PUBLIC ADDRESS OR INTERCOM SYSTEM; [13.TELEPHONE; <br /> ❑4.PAGERS; ©5.ALARM SYSTEM; ❑6.PORTABLE RADIO <br /> NOTIFICATIONS TO NEIGHBORING FACILITIES THAT MAY BE AFFECTED BY AN OFF-SITE RELEASE WILL OCCUR BY:(Check all that apply) C3_ <br /> ® 1.VERBAL WARNINGS; ❑2.PUBLIC ADDRESS OR INTERCOM SYSTEM; ❑3.TELEPHONE; <br /> ❑4.PAGERS; ®5.ALARM SYSTEM; ❑6.PORTABLE RADIO <br /> EMERGENCY RESPONSE AMBULANCE,FIRE,POLICE AND CHP.............................................. 9-1-1 <br /> PHONE NUMBERS: CALIFORNIA EMERGENCY MANAGEMENT AGENCY(CAL/EMA)...................... (800)852-7550 <br /> NATIONAL RESPONSE CENTER(NRC)............................................. (800)424-8802 <br /> POISON CONTROL CENTER........................................................ (800)222-1222 <br /> C <br /> LOCAL UNIFIED PROGRAM AGENCY PA/CUPA ................................... <br /> C4. U <br /> OTHER(Specify): <br /> NEAREST MEDICAL FACILITY/HOSPITAL NAME: DaIDerDn HOS(Jltal CIS (209)207-5236 `7' <br /> AGENCY NOTIFICATION PHONE NUMBERS: CALIFORNIA DEPT.OF TOXIC SUBSTANCES CONTROL(DISC) .... (916)255-3545 <br /> REGIONAL WATER QUALITY CONTROL BOARD.................. (916)464-3291 Ca <br /> U.S.ENVIRONMENTAL PROTECTION AGENCY(US EPA)........... (800)300-2193 <br /> CALIFORNIA DEPT OF FISH AND GAME(DEG).................... (916)358-2900 <br /> U.S.COAST GUARD............................................. (202)267-2180 <br /> CAvoSHA..................................................... (916)263-2800 <br /> STATE FIRE MARSHAL ......................................... 916)445-8200 <br /> OTHER(Specify): <br /> CIO <br /> OTHER(Specify): <br /> cD. Ca <br /> Rev.06/27/11 <br />