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9 - s <br /> Wier <br /> t; or <br /> UNDERGROMI IfORAGt? • - EGTION IREPd� P <br /> Itp11wo STORAGE TANK OVERATE VAL IN <br /> _ ._— <br /> tioll <br /> DESIGNATLI) I ► NVIRG I . 1ACIiIl` YINFORMATIONU � UST �pe(' °{ InSpec <br /> IT <br /> , SJ.-d- - - - - <br /> 1 ` . , . , Irf i ,t frnnr , fuini n ,. J _ <br /> uu• :r. � ;io- no1, i„ ION <br /> •• `•' �( OPERATOR INF RO NAT <br /> hU � f � IL �r4CNAlf 1111N111 I ' ( , <br /> do'D TAN OPERA <br /> ro <br /> ' <br /> III of Dos, natud us (-4*, <br /> �� "w — ICC rerlfficat+on EWratton Data <br /> VL <br /> ` -�_ COMPLIANCE ISSUES r -- <br /> -' ow-up action. <br /> nswers of N' or 'NA ' in ,ems VU through XI m In ad in this section and <br /> C� � c� <br /> I <br /> IV , CERTIFICATION BY DESI TED U T OPERATOR CONDUCTING THIS INSPECTION <br /> reby certify that the visual inspection s orm V Ifull compliance with California Code of Regulations, Title 23, <br /> ision 3 . Chapter 16, Section 2716 and n provided herein is accurate. <br /> n ignated UST Qperator tore f <br /> OW . OPE R DESCRIPTION OF FOLLOW-UP ACTIONS <br /> ssues listed in Section 11 JI a description of the toltow-up action taken or to be taken to correct the issue on the number <br /> that corresponds with th er fine of the compliance issue listed above in Section lll, <br /> i <br /> r <br /> , <br /> S <br /> O PERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <br /> vi Section III "C ISSUES ' and rovided a description in Section V of the action taken or to be taken <br /> the issues discovers - p <br /> !operator (Print) — <br /> UST Ownerl0perator Signature Date igned <br /> l <br /> ID = kientificalEn, UST = Urdergound Storage Tank, ICC = Inlamational Code Cotax i <br />