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IM y10Cncn <br /> CD O00cn <br /> 'te� o <br /> 0 <br /> Z191 <br /> o o <br /> aX\c sv <br /> CD <br /> IM �yQ �o� �av, _< <br /> = Underground Storage Tank �� � No Q <br /> Designated UST Operator Visual Inspection Report �� 5� <br /> Zy� ata J,o� ye�a$e N w <br /> 5,OWNER/OPERATOR DESCRIPTION OF FOLLOW-ElP ACTION N <br /> Number the follow up actions to correspond to appropriate compliance issues from Se .`o�eQt�` eaaa e� N m <br /> r o <br /> 41 <br /> a .00a`c <br /> W <br /> O� N O <br /> N r <br /> O <br /> 2 N � <br /> C� <br /> Q ca , D <br /> � � N <br /> W <br /> N <br /> d <br /> b.OWNER/OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTSCD <br /> 66� <br /> F � <br /> '►- I have reviewed the results of the designated UST operator inspection report and provided a <br /> f description of the action(s)taken or to be taken to correct any compliance issues discovered. <br /> Name of UST Owner/Operator(print) ,.s <br /> (D <br /> UST Owner/Operator Signature Date Signed <br /> 7.INSPECTION HISTORYCD <br /> rP <br /> Has each follow-up action of Section 3 from the previous Designated UST Yes No NA o <br /> Operator Inspection Report been completed appropriately? <br /> (Attach documentation verifying appropriate service to this report.) � <br /> 8. RELEASE DETECTION ALARM HISTORY ¢, <br /> Attach a copy of the alarm history report/ioq to this report. <br /> Is the monitoring system powered on and in proper operating mode? Yes No NA <br /> L o <br /> Has each alarm since the previous inspection been responded to appropriately? <br /> (Attach documentation verifying appropriate service to this report.) El 11:1 CD <br /> a <br /> Have all containment sumps,that have had an alarm since the previous CD <br /> 0 <br /> designated UST operator inspection report, been responded to by a qualified13 D 0 <br /> service technician? I — <br /> i0 co <br /> 1 �13 <br /> CD CD <br /> All answers marked"No"must be described by the designated UST operator in Section 3. <br /> CQ CD O <br /> m z Q, co <br /> � o V <br /> o <br /> v, <br />