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fCLEINFELOER <br /> prl�n,PenfR.•r1.a.,�,:;!rp�a <br /> ABOVEGROUND STORAGE TANK ANNUAL INSPECTION <br /> FORM INTERSTATE TRUCK CENTER.,STOCKTON, SAN <br /> Inspector: 155 C"Ay � f JOAQUIN <br /> Signature- DateCompleted: y <br /> Category: Venting Insulated Tanks <br /> Inspection}tem: Vents free of Emergency vent Insuiation Are there noticeable Mold on insulation? Insulation exhibiting Is the Has the tank <br /> obstructions? operable?Lift missing? areas of moisture an <br /> damage. insulation liquid level <br /> as required? the insuiation? sufficiently sensing <br /> protected device been <br /> from water tested for <br /> intrusion? proper <br /> operation? <br /> al Storage or Usage Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No <br /> Location <br /> 1 747+' <br /> Comments: <br /> Nate: Enter NA for questions that are not applicable for the specific tank. <br /> 20162686A01AISAC16R33380 Page 3 of 4 February 19, 2016 <br /> 0 2016 Kleinfelder <br />