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Kl-EINFE'L QER <br /> ABOVEGROUND STORAGE TANK ANNUAL INSPECTION <br /> FORM INTERSTATE TRUCK CENTER.,STOCKTON, SAN <br /> JOAQUIN <br /> Inspector: . Lr-_,f�,' J� Signature: _ F � Date Completed: <br /> Category: Venting Insulated Tanks <br /> Inspection Item: Vents flee 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 /> i'i, as required? the insulation? sufficiently sensing <br /> ?i protected device been <br /> from water tested for <br /> intrusion? proper <br /> operation? <br /> Oil Storage or Usage yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No <br /> Location <br /> Comments: <br /> Note: Enter NA for questions that are not applicable for the specific tank. <br /> 20162686.001 AISAC16R33380 Page 3 of 4 February 19,2016 <br /> 0 2016 Klei NoIdor <br />