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UNDERGROUND STORAGE TANK <br /> /00 JONATO UNDERGROUNMONEEMENNEENEW�D STORAGE TANK OPERATOR VISl1AL INSPECTION REPORT ( Page t of 2 ) <br /> L FACILITY INFORMATION <br /> 100 <br /> �0 eiWof Designate UST Operator Inspection <br /> I) Nie <br /> e,ne as Facl Name or Di3A -Doing Bi a : nr <br /> , r; ; A!n) <br /> {- <br /> sitel� <br /> II DESIGNATED UNDERGROUND_STORAGE TANK OPERATOR INFORMATI.ON <br /> �ated US orator nnf as shown on tho ICC CortiCralion .J P lone 11 <br /> Cetion q ICG Cerllficalion Exptralion Date <br /> . y 1 � � �-- - -�• 2v _ _ <br /> 111 . COMPLIANCE ISSUES <br /> of "N " or "NA " in sections VN through XI must be explained in this suction and may require lollow-up action. <br /> i <br /> c <br /> ;a. <br /> 2. <br /> IV. CERTIFICATION BY DESIGN ED UST OPERATOR CONDUCTING THIS INSPECTION <br /> lereby certify that the visual inspection was p ed in full compliance with California Code of Regulations, Title 23,_ <br /> 6 and all the ' or tion provided herein is accurate. <br /> vision 3 , Chapter 16, Section 271 <br /> signatea UST Operator Signature <br /> V. OWNER / RAT R DESCRIPTION OF FOLLOW-UP ACTIONS <br /> lissues listed in Section 111 a ust have a descripti of the follow-up action taken or to be taken to correct the issue on the number <br /> eRcorresponds with the line of the co Gn ce issue listed above in Section ill. <br /> 1 . <br /> 2 . <br /> 3 . <br /> 4 , <br /> 5 , <br /> g - - - <br /> 7 . <br /> 8 , <br /> 9 , <br /> 1 � <br /> I <br /> Io , <br /> a <br />