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• <br /> Pre-Inspection <br /> Health and Safety Assessment <br /> Facility Name: Olympic Tune <br /> FA#: FA0016030 <br /> Location: 400 N. Cluff Ave. #A Lodi, CA 95240 <br /> PR#: PR0523792 <br /> BusinessT e: Manufacturing Plant <br /> Date: Apr 1 2015 <br /> Initiall Completed By: Aris Veloso <br /> Instructions: Fill out this form as best as possible before the initial inspection and complete the remaining information during orjaerthe inspection. Subsequent Inspections: Review facility file and chemical inventory information, along with the information oform, to become familiar with potential hazardous substances and/or conditions at the facility and any control or precautimeasures that should be taken prior to conducting the inspection activity. Updatelcomplete form as needed.Sign and date bel <br /> Chemical Hazards Ph sical Hazards <br /> ® Carcino ens: etroleum roducts ❑ Ox en Deficiency: <br /> ® Corrosives: spent lead acid batteries ❑ Noise: <br /> ® Flammables: etroleum nrnflucts ❑ Excavations: <br /> ❑ Gases: ❑ Climbin <br /> - El <br /> IS Metals:fuel filters ❑ Ex Iasi- <br /> 0 Oxidizers: [9 Heav E ui menta vehicles <br /> ❑ PCBs: ® Heat or Cold Stress: hot weather <br /> ❑ Ex losives: ❑ Other: <br /> Biolo [cal Hazards Personal Protective E ui ment <br /> ❑ Dos ® Hard Hat ❑ CPC-T vek <br /> ❑ Snakes ® Safet Vest ❑ CPC—Other: <br /> ® Insects ® Protective Boots ❑ APR Res irator <br /> ❑ Poisonous Plants ® Go les/Glasses ❑ SCBA Res iraior <br /> ❑ Other: 5a 'le,r'nn Protection ❑ Other: <br /> By signing below, I am declaring that I have reviewed the health and safety information for this facility prior to my <br /> inspection and that I have performed, and will perform during the inspection, the following actions: <br /> I have reviewed this form and the facility file for information on the business type of operation,compliance history, prior <br /> releases and res arise, and other health and safet F related information. <br /> I have reviewed the properties and hazards associated with the chemicals in the chemical inventory submitted by the <br /> facilit . <br /> I have searched out and evaluated information on the properties of the chemicals at the facility, using the internet and <br /> other resources,for chemicals I am not familiar with at this time. <br /> I have reviewed the facility information with my supervisor if I could not determine the most appropriate health and safety <br /> precautions needed for this facility. <br /> I have gained an awareness Wine potential hazards at the facility and have determined the appropriate health and safety <br /> precautions needed to perform m in, ection. <br /> Before beginning the inspection, I will review the facility's health and safety information and rules with the owner/manager <br /> and wear theappropriate personal rotective a ui ment. <br /> During the inspection, I will observe the labeling and condition of hazardous materials containers and conveyances, the <br /> posting of placards and warning signage, and the actions of the facility employees and guests to identify any potential <br /> unsafe conditions that ma arise durin the inspection. DateStaff Signature Date <br /> Staff Signature <br /> 1 1-S <br /> San Joaquin County Environmental Health Department; 1868 E. Hazelton Avenue;­"Stockton, A 95205;209.468.3420 <br /> Pre-Inspection Health&Safety Assessment <br /> EHD48- 0642-2013 <br />