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Pre-Inspection Health and Safety Assessment Facility Name: Castle Auto otive FA#: 5839 Location: 2315 N EI Dorado Street PR#: 537590 Business Type: Auto Repair Initially Completed By: Garrett ackus Date: Oct 16 2013 Instructions: Fill out this form aq best as possible before the initial inspection and complete the remaining information during or after the inspection. Subsecluent 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 r rior to conducting the inspection activity. Updatelcomplete form as needed.Sign and date below. Chemical Hazards Physical Hazards ❑ Carcinogens: ❑ Oxygen Deficienc : ❑ Corrosives: ❑ Noise: ® Flammables: ❑ Excavations: ❑ Gases: ❑ Climbing: ❑ Metals: ❑ Explosion: ❑ Oxidizers: ® Heavy Equipment: ❑ PCBs: ❑ Heat or Cold Stress: ❑ Explosives: ❑ Other: Bio lo ical Hazards Personal Protective Equipment ❑ Dos ® Hard Hat ❑ CPC-T vek ❑ Snakes ® Safety Vest ❑ CPC—Other: ❑ Insects ® Protective Boots ❑ APR Res irator ❑ Poisonous Plants ® Go les/Glasses ❑ SCBA Respirator ❑ Other: ® Hearin Protection ❑ Other: By signing below, I am ded ring that I have reviewed the health and safety information for this facility prior to my inspection and that I have p rformed, and will perform during the inspection, the following actions: I have reviewed this form and he facility file for information on the business type of operation, compliance history, prior releases and response, and o her health and safety related information. I have reviewed the propertieand 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 precautions needed to perfor my inspection. Before beginning the inspection, I will review the facility's health and safety information and rules with the owner/manager and wear theappropriate pers nal protective equipment. During the inspection, I will orve the labeling and condition of hazardous materials containers and conveyances, the b e posting of placards and warn signage, and the actions of the facility employees and guests to identify any potential unsafe conditions that may ari a during the inspection. Skff Signature Date Staff Signature Date San Joaquin County EnvirDnmental Health Department; 1868 E. Hazelton Avenue; Stockton, CA 95205;209.468.3420 EHD 48- 06-12-2013 Pre-Inspection Health&Safety Assessment