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{ KLE11VF-E1.DEfi? <br /> ABOVEGROUND STORAGE TANK ANNUAL INSPECTION <br /> FORM INTERSTATE TRUCK CENTER.,STOCKTON, SAN <br /> JOAQUIN <br /> Inspector: Signature: v Date Completed: z <br /> Category: Level and Overfill Prevention Electrical Equipment <br /> Instrumentation of shop-Fabricated <br /> Tanks <br /> Inspection Item: Does the tants liquid Are overfill Are tank Is electrical wiring for <br /> €eves sensing device prevention grounding fines control boxesilight in good <br /> �.. <br /> r• operate as required? devices in in good candition4 <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 /> 20162686.001 AISACI6R33380 Page 4 of 4 February 19,2016 <br /> d 2016 Kleinfelder Y <br />