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6� <br /> ICLEINFELaER <br /> ABOVEGROUND STORAGE TANK ANNUAL INSPECTION <br /> FORM INTERSTATE TRUCK CENTER.,STOCKTON, SAN <br /> JOAQUIN <br /> Inspector: t�'.: y L it ��� T Signature: J, Date Completed: II 1 Sr i <br /> Category: Venting Insulated'hanks <br /> Inspection Item: Vents free of Emergency vent Insulation Are there noticeable Mold on insulation? Insulation exhibiting Is the Has the tank <br /> i obstructions? operable?Lift missing? areas of moisture on damage? insulation liquid level <br /> as required? the insulation? sufficierftI sensing <br /> � w Y <br /> r protected device been <br /> 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 /> PLC t sr H <br /> Comments: <br /> Note: Enter NA for questions that are not applicable for the specific tank. <br /> 20162686.001AISACI6R33380 Page 3 of 4 <br /> 02016 Kleirdelder February 19, 2016 <br />