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Pre-Inspection Health and Safety Assessment Facili Name: Armor Struxx FA#: 0018160 Location: 850 Thurman St. PR#: 0526803 Business? e: Armor reinforcements initially Completed By: Jamie DeLaRosa Date: Aug6 2015 Instructions: Fill out this form as best as possible before the initial inspection and complete the "information tion during or after the inspection. Subsequent Inspections: Review facility file and chemical inventory informatioinformation on thisform, to become familiar with potential hazardous substances and/or conditions at the facilitol or precautionarymeasures that should be taken prior to conducting the inspection activity. Updatelcomplete formn and date below. Chemical Hazards Ph sical Hazards ❑ Carcino ens: ❑ Ox an Deficienc : ❑ Corrosives: ❑ Noise: ® Flammables: acetone ❑ Excavations: ❑ Gases: ❑ Climbin : ❑ Metals: ❑ Ex losion: ❑ Oxidizers: ❑ Heav E ,4 menta ❑ PCBs: ❑ Heat or Cold Stress: ❑ 1 Explosives: ❑ Other: Biolo ical Hazards Personal Protective E ui ment ❑ Do s ❑ Hard Hat ❑ I CPC-T vek ❑ Snakes ❑ Safet Vest ❑ CPC—Other: ❑ Insects ❑ Protective Boots ❑ I APR Res irator ❑ Poisonous Plants ® Goggles/Glasses ❑ SCBA Respirator ❑ Other: ❑ Hearin Protection ❑ Other: By signing below, I am declaring that I have reviewed the health and safety information for this facility prior to my inspection and that I have performed, and will perform during the inspection, the following actions: I have reviewed this form and the facility file for information on the business type of operation, compliance history, prior releases and response, and other health and safety related information. I have reviewed the properties and hazards associated with the chemicals in the chemical inventory submitted by the facility. I have searched out and evaluated information on the properties of the chemicals at the facility, using the internet and other resources,for chemicals I am not familiar with at this time. I have reviewed the facility information with my supervisor if I could not determine the most appropriate health and safety precautions needed for this facility. I have gained an awareness of the potential hazards at the facility and have determined the appropriate health and safety recautions needed to perform m inspection. Before beginning the inspection, I will review the facility's health and safety information and rules with the owner/manager and wear the appropriate personal rotective a ui ment. During the inspection, I will observe the labeling and condition of hazardous materials containers and conveyances, the posting of placards and warning signage, and the actions of the facility employees and guests to identify any potential unsafe conditions that may arise durin the ins ection. St t e Date Staff Signature Date -IS San Joaquin County Environmental Health Department; 1868 E. Hazelton Avenue; Stockton,CA 95205;209.468.3420 Pre-Inspection Health&Safety Assessment EHD 48- 06-12-2013