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VST OperaL— o -V � � <br /> TIO <br /> Section 3 m x M. <br /> ° �,igflati� W-UP AC es from L. 0 N <br /> -U LO liance issu <br /> CD CRIFTION OF FOL comp v O N <br /> IZATpR D0 ozld to appropriate <br /> _ m v <br /> ° pwo OPE actions to corresp a <br /> rn 5 fallow P [U d 1 O v <br /> _ Number the 'P�,�,/�f.� a a <br /> CD <br /> � #c ijr�n� , � D <br /> ¢ O <br /> co D <br /> O X <br /> C) <br /> C) 0 <br /> 00 <br /> W <br /> O <br /> N CO <br /> O <br /> N O <br /> v <br /> (D C j <br /> M.I <br /> N <br /> ` O <br /> 7 (D <br /> N 77 <br /> r B. OWNE=R OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTS <br /> 1 have reviewed the results of the designated UST operator inspection report and provided a <br /> description of the action fs)taken or t be taken to correct any compliance issues discovered. m o <br /> Name of DST Owner/Operator(print) ~' <br /> I/Vr�t j2 Q <br /> UST Owner/Operator SignatureDate Signed 0 y <br /> 7. INSPECTION HISTORY <br /> Has each follow-up action of Section 3 from the previous Designated UST Yes No NA <br /> Operator Inspection Report been completed appropriately? <br /> Zl <br /> CD <br /> 0 <br /> 0 <br /> a <br /> � p <br /> v <br /> co X <br /> cn O <br /> CTI <br /> c� <br /> Cn N <br /> 00 <br />