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Environmental Health Department Facility Name: Mountain Mikes Pizza Facility Address: 1255 Lillian Ave, Escalon, CA 95320 Facility Phone: (209) 838-8200 Program: 1919 - HMBP-CO2 Only Food Facility Inspection Type: ROUTINE INSPECTION - Operating Permit Date: August 29, 2018 CERS ID: 10642324 Inspection Contact: Tamra McCowan Consent For: Consent Given By: Tamra McCowan, manager Title: manager Phone: (209) 838-8200 T Inspection £ Photos £ Samples Hazardous Materials Program Inspection Report R = Repeat violation COS = Corrected on site during inspectionV = Violation CCR = California Code of Regulations HSC = Health and Safety Code CFR = Code of Federal Regulations Violations 1 □ V □ R □ COS Failed to pay annual operating feesSJO 4432 2 ■ V □ R □ COS Failed to complete and electronically submit a hazardous materials business planHSC 25505, 25508(a)(1) 3 ■ V □ R □ COS Failed to establish and implement a hazardous materials business planHSC 25507 4 □ V □ R □ COS Failed to complete and/or submit the Business Activities or Owner/Operator Identification pageHSC 25508(a)(1) 5 ■ V □ R □ COS Failed to complete and/or submit hazardous materials inventory for all reportable materials on siteHSC 25506(a)(1) 6 ■ V □ R □ COS Failed to complete and/or submit a site map with all required contentHSC 25505(a)(2) 7 ■ V □ R □ COS Failed to establish and/or submit emergency response procedures for a release or threatened releaseHSC 25505(a)(3) 8 ■ V □ R □ COS Failed to submit a training program or program is not reasonable or adequate for facilityHSC 25505(a)(4) 9 ■ V □ R □ COS Failed to annually review and certify that the business plan is complete, accurate, and up to dateHSC 25508(a)(1) 10 □ V □ R □ COS Failed to submit revisions to business plan within 30 days of substantial change in operationsHSC 25508.1(a)-(f) 11 ■ V □ R □ COS Failed to provide or document initial and/or refresher training to appropriate personnelHSC 25505(a)(4) 12 ■ V □ R □ COS Failed to have the business plan readily available to facility or EHD personnelHSC 25505(c) 13 □ V □ R □ COS Failed to notify property owner that facility is subject to and in compliance with the HMBP programHSC 25505.1 14 □ V □ R □ COS Business on leased property failed to provide copy of HMBP w/in 5 days of request by property ownerHSC 25505.1 15 □ V □ R □ COS Failed to report actual or threatened release to the EHD and/or CalOES Warning CenterHSC 25510(a) 16 □ V □ R □ COS Failed to submit emergency response plan when not meeting Ag handler exemption requirementsHSC 25507.1 17 □ V □ R □ COS Failed to submit training program when not meeting Ag handler exemption requirementsHSC 25507.1 18 □ V □ R □ COS Failed to establish and implement a HMBP when not meeting remote unstaffed facility exemptionsHSC 25505, 25507.2 19 □ V □ R □ COS Failed to submit a written response within 30 days of receiving an inspection reportHSC 25511 1010 □ V □ R □ COS Unlisted Administration/Documentation violation See below 1020 □ V □ R □ COS Unlisted Training violation See below 1030 □ V □ R □ COS Unlisted Operations/Maintenance violation See below 1040 □ V □ R □ COS Unlisted Release/Leaks/Spills violation See below 1045 □ V □ R □ COS Unlisted Release/Leaks/Spills - Local Ordinance See below 1050 □ V □ R □ COS Unlisted Abandonment/Illegal Disposal/Unauthorized Treatment violation See below 1055 □ V □ R □ COS Unlisted Abandonment/Illegal Disposal/Unauthorized Treatment - Local Ordinance See below Page 1 of 4 FA0018622 PR0540403 SC001 08/29/2018 EHD 19-01 Rev. 10/31/2017 Hazardous Materials Program OIR 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com