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KLElNFELoHR <br /> �Br.�M1i+'eo+re.Aiyr:r uM1rrMrs <br /> ABOVEGROUND STORAGE TANK ANNUAL INSPECTION <br /> FORM INTERSTATE TRUCK CENTER.,STOCKTON, SAN <br /> p JOAQUIN <br /> Inspector: _�i1�5 5 Gyi���: J4 Signature: DateCompleted: 1: <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 /> r as required? the insulation? sufficiently sensing <br /> protected device been <br /> from water tested for <br /> 1 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 /> i I -T i <br /> Comments: <br /> Note: Enter NA for questions that are not applicable for the specific tank. <br /> 20162686.001AISAC16R33380 Page 3 of 4 February 19, 2016 <br /> 0 2016 Kleinfelder <br />