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'. E NFEL�ER <br /> ` BnghraroFfp.Aigfr safut+ons. <br /> ABOVEGROUND STORAGE TANK ANNUAL INSPECTION <br /> FORM INTERSTATE TRUCK CENTER., STOCKTON, SAN <br /> OAQUIN <br /> Inspector: _ Signature: -� — Date Completed: 1 <br /> Category: Level and Overfill Prevention Electrical Equipment <br /> Instrumentation of Shop-Fabricated <br /> Tanks <br /> Inspection Item: Does the tarn liquid Are overfill Are tank Is electrical wiring for <br /> level sensing device prevention grounding tines control boxeslilght in good <br /> e operate as required? devices in in good condition? <br /> proper working condition? <br /> Condition? <br /> Ol Storage or Usage yes <br /> Location Na 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 /> 20152686.001 AISACI 6R33380 Page 4 of 4 February 19, 2016 <br /> &)2016 Kleintelder <br />