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ACL EANFEL0,5-,4 <br /> 6r:ghi Ceopfe.Rrglr Salufpns. <br /> ABOVEGROUND STORAGE TANK ANNUAL INSPECTION FORM <br /> INTERSTATE TRUCKING INC., STOCKTON, SAN JOAQUIN <br /> Inspector: ,R-�,,. _ Signature: 4 Date Completed: _ <br /> Category: Tank Containment Tank Foundation and Supports Cathodic <br /> Inspection Item: Containment Drainage Evidence of Cracking or spal ling of Tank supports in Water able to drain Grounding CP system <br /> structure in pipeslvalves fit tank settlement concrete pad or ring satisfactory condition? away from tank? strap functional? <br /> satisfactory for continued or foundation wall? secured and <br /> condition? service? washout? in good <br /> condition? <br /> Cil Storage or Usage <br /> Location Yes No Yes No Yes No Yes No Yes leo Yes No Yes No Yes No <br /> io <br /> Comments: <br /> Note: Enter NA for questions that are not applicable for the specific tank. <br /> 20162686.001A1SAC16R33380 Page 1 of 4 February 19, 2016 <br /> U 2016 Kleinfelder <br />