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ICLEINFELDER <br /> er�h[Peopf+.Rglfi$olufiply, <br /> ABOVEGROUND STORAGE TANK ANNUAL INSPECTION <br /> FORK! INTERSTATE T CK CENTER., STOCKTON, SAN <br /> QUIN <br /> Inspector: Signature: _ Date Completed: <br /> Category: Venting Insulated Tanks <br /> Inspection Item: Vents free of Emergency vent Insulation Are there noticeable Mold on insulation? Insulation exhibiting Is the Has the tank <br /> obstructions? operable?Lift missing? areas of moisture on damage? insulation liquid level <br /> t as required? the insulation? sufficiently sensing <br /> protected device been <br /> f from water tested for <br /> intrusion? proper <br /> operation? <br /> Oil Storage or Usage yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No <br /> Location <br /> AJIA- <br /> /Y <br /> Comments: <br /> Note: Enter NA for questions that are not applicable for the specific tank. <br /> 20162686.001AISAC16R33380 Page 3 of 4 February 19, 2016 <br /> ©2036 Kleinfe€der <br />