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Under :round Storage Tank <br /> Designatin. UST 0 <br /> erator Visual Inspection Report <br /> . OW ERIQPERATOFt DC 11PTION ,QF FOLLOW-UP ACTION <br /> Num 'e the follow up action 3 correspond to appropriate compliance issues from Section 3. <br /> 6. OWNER 1 OPERATOR; i CNOWLEDOEMENT Ol= INSPECTION RESULTS ' <br /> I have reviewed the result ' .f the designated UST operator inspection report and provided a <br /> desCrition of the action; ) taken or to lie taken to correct any compliance is su eq discovered. <br /> Name of UST Owner l Ope'r 3 r (print) <br /> UST Owner/Operator Signa r Date Signed <br /> r <br /> 7. 1N'SPECTIONHISTORY <br /> Has paah follow-up action o ection 3 from the previous Designated UST Yes No NA <br /> Operator Inspection Report een completed appropriately? ❑ <br /> Attach documentation verif I appro rime service to this report. I <br /> 8. RE4EASE,I)ETECTION,411LARM HISTORY - <br /> Attach a copy of the alarm 01 story rep .rrt/fog to this report. Yes No NA <br /> Is the monitoring system pold4red on and in proper operating mode? Fe ❑ <br /> Has each alarm since the p �' ious ins pec ltI�ion been responded to appropriately? ❑ ❑ <br /> (Attar documentation verif g appropriate service to this report.) <br /> Have all containment sumps, that have had an alarm since the previous <br /> design tec[ UST operator in action repo, been responded to by a qualified ❑ ❑ <br /> servic�technician? <br /> All anis ers marked "No"m be deserib d by the designated UST operator in Sectio 3. <br /> Page 2of4 <br />