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�fCLEINFEL�ER <br /> ���`-Wight ilw�ie.Rp;y Sol�ria�s <br /> ABOVEGROUND STORAGE TANK ANNUAL INSPECTION <br /> FORM INTERSTATE TRUCK CENTER., STOCKTON, SAN <br /> QUIN <br /> Inspector: ytl� Signature: _ _ Date Cgmpleted: .. �] 'T <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 /> 0 as required? the insulation? sufficiently sensing <br /> protected device been <br /> C;'[W from water tested for <br /> intrusion? proper <br /> operation? <br /> 01 Storage or Usage Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No <br /> Location <br /> Comments: <br /> Note: Enter NA for questions that are not applicable for the specific tank. <br /> 24162686.001A1SAC16R33380 Page 3 of 4 <br /> @2016 Kleinfelder February 19, 2016 <br />