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KLE1111FELL)ER <br /> nrufhr Moa.'e.Nihr nirtgirr <br /> ABOVEGROUND STORAGE TANK ANNUAL INSPECTION <br /> FORM INTERSTATE TRUCK CENTER.,STOCKTON, SAN <br /> JDAQUIN <br /> Inspector: �lc?� L >` •��a j,- Signature: * 4�' 2, bate Completed: Z S <br /> Category: Level and Overfill Prevention Electrical Equipment <br /> Instrumentation of Shop-Fabricated <br /> Tanks <br /> Inspection Item: Does the tank liquid Are overfill Are tank Is electrical wiring for <br /> r level sensing device prevention grounding lines control boxWtight In good <br /> G operate as required? devices in in good condition? <br /> proper working condition? <br /> condition? <br /> Oil Storage or Usage Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No <br /> Location <br /> v' iU�r <br /> 0' <br /> Comments: <br /> Note: Enter NA for questions that are not applicable for the specific tank. <br /> 20162686.001AISAC16833380 Page 4 of 4 February 19, 2016 <br /> 0 2015 Kleinfelder <br />