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S A N J 0 A Q I I I Irl Environmental Health Department <br /> CCUN r <br /> Hazardous Materials Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> JACK IN THE BOX#557 611 W GRANT LINE RD, TRACY February 19, 2021 <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> Item# Remarks <br /> 4 HSC 25508(a)(1) Failed to electronically submit the Business Activities or Owner/Operator Identification page. <br /> OBSERVATION: The Business Owner/Operator Identification form was not submitted or complete. No secondary <br /> emergency contact was provided. <br /> REGULATION GUIDANCE: This information must be current and submitted as part of the business plan. <br /> CORRECTIVE ACTION: Immediately log into the California Environmental Reporting System (CERS)at <br /> http://cers.calepa.ca.gov/, enter the correct or updated information, and submit to the EHD for approval. <br /> This is a minor violation. <br /> 5 HSC 25505(a)(1) Failed to electronically submit hazardous materials inventory for all reportable materials on site. <br /> OBSERVATION: The Hazardous Materials Inventory forms for carbon dioxide were not complete. The Federal <br /> Hazard Categories are not filled in. The warning sign is indicated for Obsolete Data Element and was not corrected. <br /> REGULATION GUIDANCE :This information must be current and submitted as part of the business plan. <br /> CORRECTIVE ACTIONS: Immediately log into the California Environmental Reporting System (CERS)at <br /> http://cers.calepa.ca.gov/, enter the correct or updated information, and submit to the EHD for approval. <br /> This is a minor violation. <br /> 7 HSC 25505(a)(3) Failed to electronically submit an adequate ER procedures for a release or threatened release. <br /> OBSERVATION: The emergency response(ER)procedures were lacking or inadequate. The Emergency <br /> Response Plan Section C-C6 and C7 Nearest Medical Facility/Hospital Phone Number is not filled in. <br /> REGULATION GUIDANCE:A business plan shall include the following emergency response procedures for a <br /> release or threatened release of hazardous materials, including, but not limited to,the following: <br /> -immediate notification of local emergency personnel and the Environmental Health Department(EHD) <br /> -procedures for the mitigation of a release or threatened release to minimize any potential harm or damage to <br /> persons, property, or the environment <br /> -evacuation plans and procedures, including immediate notice,for the site <br /> CORRECTIVE ACTION: Immediately log into the California Environmental Reporting System (CERS)at <br /> http://cers.calepa.ca.gov/, upload the correct or updated information, and submit to the EHD for approval. <br /> This is a repeat violation, Class II. <br /> FA0003174 PR0520666 SCO01 02/19/2021 <br /> EHD 19-01 Rev.9/16/2020 Page 2 of 3 Hazardous Materials Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />