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0 Pre-Inspection • Health and Safety Assessment Facility Name Advanced Industrial Coatings Inc. _ _ _ FA#: FA0011160 Location: 950 Industrial Dr., Stockton,CA 95206 PR#: PRO520710 Business Type. Industrial paint and coating process Date: 1213115 Initiall Com leted B : Robert Lopez Instructions: Fill out this form as best as possible before the initial inspection and complete the remaining information during or after the inspection. Subsequent Inspections: Review facility file and chemical inventory information, along with the information on this form, to become familiar with potential hazardous substances and/or conditions at the facility and any control or precautionary measures that should be taken prior to conducting the inspection activityy. a Updt lcompllete form as needed. Sign and date below. Ph Hazards Chemical Hazards ❑ Ox en Deficienc : ❑ Canino ens: ❑ Noise: X Corrosives: ❑ Excavations: X Flammables: ❑ Climbin : X Gases: ❑ Ex losion: ❑ Metals: ❑ Heav E ui ment: ❑ Oxidizers: ❑ Heat Stress: ❑ PCBs: [I Cold Stress: ❑ Ex losives: ❑ Other: X Other:Water base aint and owder coat aint Personal Protective E ui ment Biolo ical Hazards X Hard Hat ❑ CPC-T ver, ❑ Do s X Safe Vest ❑ CPC—Other: ❑ Snakes X Protective Boots ❑ APR Res irator ❑ Insects ❑ Go les/Glasses ❑ SCBA Res irator ❑ Poisonous Plants ❑ Hearin Protection ❑ Other: ❑ 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 cf 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 facilit . tion on the properties 0f the chemicals at the facility, using the Internet an I have searched out and evaluated informa 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 recautions needed for this facilit . 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 theappropriate ei sonal 11 0tective a uipment. During the inspection, I will observe the labeling and condition of hazardous materials containers and conveyances,the posting of placards and waming signage, and the actions of the facility employees and guests to identify any potential unsafe conditions that ma arise durin the ins ecti n.Date Staff Signature Date Staff Signature 1213/15 San Joaquin County Environmental Health Department; 1868 E. Hazelton Avenue;Stockton, CA re 95205; 205;n 09.468 .342&safety0ssessmenl EHD 48- 06-12-2013