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UNDERGROUND STORAGE TANK <br /> pERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT ( Page of 2) <br /> ED UN 1 , FACILITY INFORMATION f 1 ,(j4 , 1fir„rtod UST Operator Inspection <br /> a pr f )HA Uninq Hu:inu,;. A !4 <br /> Snc Na <br /> ame ! If ' r :nrla <br /> ddr 5 V'VA <br /> DESIGN TED UNDERGROUND STORAGE IAN 01 ' 1 l ? A Itr1f INFORMATION <br /> 11 . 11` r ff ro I , r.t shrntin no 7hn Ir ;r : c orfrGcafrnrr <br /> pled LIST 01w(, � l _� [ ' l �l �tJ 1 *� lei <br /> \n �1 - J if G certiftcalion Fxpirahon UatH <br /> nN <br /> Ill . COMPLIANCE ISSUES <br /> in sections Vll througXI must be explained in this section it <br /> I <br /> I <br /> I <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS INSPECTION <br /> ify that the visual inspection was or in full compliance with California Code of Regulations , Title 23 , <br /> hapter 16, Section 2716 and all the i tion provided herein Is accurate . <br /> T Operator Signature <br /> V. OWNER 10 <br /> SCRIP ION OF FOLLOW-UP ACTIONS <br /> ed in Section 111 above must have a descrip follow action taken or to be taken to correct the issue on the number <br /> esponds . h the number line of the complia list ove in Section 111. <br /> VI . OW DG OF COIN <br /> wed Section III " CO de action V if ae on'taken or to be taken <br /> he issues discove <br /> Owner/Operator (P rator <br /> -- <br /> Environmental Tank, <br />