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Sep 21 1612:25p Jiffylube 598 2 92398763 p.1 <br /> ' San Joaquin County nt DECEIVE <br /> Environmental Health Departure-18 <br /> 9w <br /> Stockton, Californ ; 05 6232 <br /> tld <br /> 1868 East Hazelton Avenue. ) 468-3433 Web: <br /> www i <br /> Telephone: (209)468-3420 Fax: (209 <br /> Hazardous Materials Program lnspe�t►on Repot <br /> Faulny Phone: u At rlCIMgTNAMIT <br /> Facility Name: <br /> Phone: <br /> Facility Address: True: <br /> Inspection(:pleat Program: - <br /> lnspe°1wn Type: <br /> Consent Fa: -, ." . .-,. ,,.-:: non <br /> Code C1-12'Code of Federal Regulations R=Repeat violation <br /> Cal'' M COS`C°rmcla°on site during irrspee <br /> fCCR= Code of Regulations NSC=Health and slaty <br /> V=•nolatlon <br /> Violations <br /> - _------------ ov oR 000S <br /> _-- Falod to oMoblid+—d� *"rst o heaardoue matenelo bualnese Plan a V u R O COS <br /> � uoc¢6607 <br /> 2 HIS 253t16(axt) Failed to electronically submit a business plan p and u to date n V o R n COS <br /> 3 HSC 25508.2 Failed to annually review and certify that the business Ian is complete:accurate.and <br /> HMBP ro ram n V u R ❑COS <br /> ito and in compliance With P 9 <br /> .r tn002a000_'r <br /> Tamed W nvltry prupeny owner tlxd facility le subject _t V o R ❑COS <br /> 5 HSC 25510 Filled to report actual or threatened release to the EHD andlor CalOES Waming Center a V o R o COS <br /> I 5 HSC 25508(a)(1) Failed to complete andlor submit the Business ActNities or Ov+nerlOperator Identification page <br /> 7 1150 75500(s) Failed Io Complete andlor edbmtt lrezardou5 materials Inventory for all reportable materials on ado o V a R n COS <br /> 8 HSC 25508.1(a){e) Failed to st�rnil revisions to HMBP v+dhln 30 days or change in business into or inventory a V a R o COS <br /> 9 HSC 26508-1 If) Failed to submit revisions to HMBP within 30 days of substantial change in operations o V r.R u COS <br /> 10 HSC 25505(a)(2) Failed to complete andlor submit a site map With all required content <br /> 11 HSC 75505(a)(3) Failed to establish andlor submit emergency response procedures for a release or threatened release o V a R o COS <br /> Failed to submit a training program or program is riot reasonable or adequate for facility <br /> oV 0 aC05 <br /> 12 HSC 25505(a}(4) r lisle Personnel .V e R c COS <br /> 13 HSC 25505(a)(4) Failed to provide or document initial andlor refresher training 10 app ap <br /> t4 HSC 25507/ Feaed to wbmit emergenuy response Plan when not meeting Ag handler exsmptbn requirements ❑V u R u COS <br /> V R aCOS <br /> 15 HSC 25507.1 Failed to submit training program when not meeting Ag handler exemption requirements <br /> oo <br /> 16 HSC 25507.2 Failed to establish and implement a HMBP when not meeting remote mataffed facility exemptions o V a R o COS <br /> 0V aR oCOS <br /> 57 HSG 25511 Failed 10 submit a written response wain 30 days of recetding an inspection report ,jV o R o COS <br /> 1010 Seebelow Unlisted AdminishatlolVDocumenlatbn vlolatien <br /> a In oCOS <br /> 1040 8Be 6elow Unlisted Releese/LeaksrSpills violation <br /> SUMMARY OF VIOLATIONS <br /> (CLASS 1,CLASS it.or MINOR-Notice to ComPIY) <br /> ItemRemar <br /> ks <br /> as <br /> HSC 25505(a)(4)Failed to provide or document initiai andlor refresher training to appropriate personnel. <br /> Phone: Date: <br /> Received by I inspector: :•:' :, <br /> (initial): <br /> Page 1 or 2 <br />