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SAN J OAQU I N Environmental Health Department <br /> COUNTY <br /> Hazardous Materials Program Inspection Report <br /> Facility Name: Facility Phone: Date: <br /> Chipotle Mexican Grill#1134 1 (303)595-4000 May 23,2018 <br /> Facility Address: CERS ID: <br /> 1442 Hulsey Way, Manteca, CA 95336 10404961 <br /> Inspection Contact: Title: Phone: <br /> Khoi Nguyen _7manager (209)823-1017 <br /> Inspection Type: Program: <br /> ROUTINE INSPECTION-Operating Permit 1919- HMBP-0O2 Only Food Facility <br /> Consent For: Consent Given By: <br /> ❑x Inspection ❑ Photos ❑ Samples I Khoi Nguyen, manager <br /> CCR=California Code of Regulations HSC=Health and Safety Code CFR=Code of Federal Regulations <br /> V=Violation R=Repeat violation COS=Corrected on site during inspection <br /> Violations <br /> 1 SJO 4432 Failed to pay annual operating fees ❑V ❑R ❑COS <br /> 2 HSC 25505,25508(a)(1) Failed to complete and electronically submit a hazardous materials business plan ❑V ❑R ❑COS <br /> 3 HSC 25507 Failed to establish and implement a hazardous materials business plan ❑V ❑R ❑COS <br /> 4 HSC 25508(a)(1) Failed to complete and/or submit the Business Activities or Owner/Operator Identification page ❑V ❑R ❑COS <br /> 5 HSC 25506(a)(1) Failed to complete and/or submit hazardous materials inventory for all reportable materials on site ❑V ❑R ❑COS <br /> 6 HSC 25505(a)(2) Failed to complete and/or submit a site map with all required content ❑V ❑R ❑COS <br /> 7 HSC 25505(a)(3) Failed to establish and/or submit emergency response procedures for a release or threatened release ❑V ❑R ❑COS <br /> 8 HSC 25505(a)(4) Failed to submit a training program or program is not reasonable or adequate for facility ■V ❑R ❑COS <br /> 9 HSC 25508(a)(1) Failed to annually review and certify that the business plan is complete,accurate,and up to date ❑V ❑R ❑COS <br /> 10 HSC 25508.1(a)-(f) Failed to submit revisions to business plan within 30 days of substantial change in operations ❑V ❑R ❑COS <br /> 11 HSC 25505(a)(4) Failed to provide or document initial and/or refresher training to appropriate personnel ❑V ❑R ❑COS <br /> 12 HSC 25505(c) Failed to have the business plan readily available to facility or EHD personnel ■V ❑R ❑COS <br /> 13 HSC 25505.1 Failed to notify property owner that facility is subject to and in compliance with the HMBP program ❑V ❑R ❑COS <br /> 14 HSC 25505.1 Business on leased property failed to provide copy of HMBP Win 5 days of request by property owner ❑V ❑R ❑COS <br /> 15 HSC 25510(a) Failed to report actual or threatened release to the EHD and/or CalOES Warning Center ❑V ❑R ❑COS <br /> 16 HSC 25507.1 Failed to submit emergency response plan when not meeting Ag handler exemption requirements ❑V ❑R ❑COS <br /> 17 HSC 25507.1 Failed to submit training program when not meeting Ag handler exemption requirements ❑V ❑R ❑COS <br /> 18 HSC 25505,25507.2 Failed to establish and implement a HMBP when not meeting remote unstaffed facility exemptions ❑V ❑R ❑COS <br /> 19 HSC 25511 Failed to submit a written response within 30 days of receiving an inspection report ❑V ❑R ❑COS <br /> 1010 See below Unlisted Administration/Documentation violation ❑V ❑R ❑COS <br /> 1020 See below Unlisted Training violation ❑V ❑R ❑COS <br /> 1030 See below Unlisted Operations/Maintenance violation ❑V ❑R ❑COS <br /> 1040 See below Unlisted Release/Leaks/Spills violation ❑V ❑R ❑COS <br /> 1045 See below Unlisted Release/Leaks/Spills-Local Ordinance ❑V ❑R ❑COS <br /> 1050 See below Unlisted Abandonment/IIlegal Disposal/Unauthorized Treatment violation ❑V ❑R ❑COS <br /> 1055 See below Unlisted AbandonmenUlllegal Disposal/Unauthorized Treatment-Local Ordinance ❑V ❑R ❑COS <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> FA0018861 PRO540064 SCO01 05/23/2018 <br /> EHD 19-01 Rev.10/31/2017 Page 1 of 2 Hazardous Materials Program OR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />