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i ACL EINFELL7ER <br /> \i�Y-erighip P%•°.Rgyt Svkr%on[. <br /> ABOVEGROUND STORAGE TANK ANNUAL. INSPECTION <br /> FORM INTERSTATE TRUCK CENTER., STOCKTON, SAN <br /> UIN <br /> Inspector: -J(14;" Signature; _ Date completed:� �q <br /> Category: Level and Overfill Prevention Electrical Equipment <br /> Instrumentation of Shap-Fabricated <br /> Tanks <br /> Inspection Item: Does the tank liquid Are overfill Are tank Is electrical wiring for <br /> level sensing device Prevention grounding lines control boxes/light in good <br /> operate as required? devices in in good condition? <br /> proper working condition? <br /> condition? <br /> Oil Storage or Usage <br /> Location Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No <br /> Comments. <br /> Note: Enter NA for questions that are not applicable for the specific tank. <br /> 20162686.001A/SACI6R33380 Page 4 of 4 <br /> 02016 Kleinfelder February 19, 2016 <br />