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fCL EINFE'L.pER <br /> ery,.nwNro er�nr sw:.roti <br /> ABOVEGROUND STORAGE TANK ANNUAL INSPECTION <br /> FORM INTERSTATE TRUCK CENTER.,STOCKTON, SAN <br /> _ JOAQUIN <br /> Inspector: IC05!s Signature: X,-z-Z&= <br /> Date Completed: �(//'z <br /> Category: Level and Overfill Prevention Eiectrical Equipment <br /> Instrumentation of Shop-Fabricated <br /> Tanks <br /> Inspection Item: Does the tank liquid Are overfill Are tank Is electrical wiring for <br /> level sensing device prevertlon grounding lines control boxes/light in good <br /> rr�{ operate as required? devices in in good condition? <br /> `t 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 /> er- <br /> Comments: <br /> Note: Enter NA for questions that are not applicable for the specific tank. <br /> 20162686.001 AISAC16R33380 Page 4 of 4 February 19, 2016 <br /> 0 2016 Kleinfelder <br />