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6638 Pacific Avenue PR0231784 <br /> January 20, 2022 Program: UST <br /> PHOTO 1: 9/28/21 DO report signed late by s �IPowner/operator. <br /> ncuf r mool-ii95-3b b <br /> F-uft:-PRor-7G Avz cheimn vrmIFK Cc M <br /> FA - - <br /> Semk <br /> Icc: <br /> VR: <br /> Designated Underground <br /> D—" UST Operator�g Storage Tank <br /> 5. OW R/OPERAT ual inspection <br /> Number the follow OR DESCRIPTION OF 1 1 Report _ <br /> uP actions to correspond to app opW teP o CTION <br /> mpliance issues from Section 3. <br /> .ode <br /> s <br /> 6. OWNER/OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTS <br /> I have reviewed the results of the designated UST operator inspection report and provided a <br /> description of the actions)taken or to be taken to correct any compliance issues discovered. <br /> Name of UST Owner/Operator(print) <br /> UST Ow, r/O r for S' nat re <br /> Date Signed <br /> T- IN ION HISTORY <br /> Has each follow-up action of Section 3 from the previous Des=USTyesOperator Inspection Report been completed appropriately? No N <br /> Attach documentation verif in a ro riate service to this re <br /> 8. RELEASE DETECTION ALARM HISTORY <br /> rdesignated <br /> copy of the alarm history report/log to this report. N <br /> Ye No NA oI <br /> nitoring system powered on and in proper operating mode? ® o' <br /> alarm since the previous inspection been responded to appropriately? I] E - <br /> cumentation verifying appropriate service to this report.) e <br /> ontainment sumps,that have had an alarm since the previous ❑ E <br /> d UST operator inspection report,been responded to by a qualified <br /> hnician? <br /> I <br /> All answers marked"No"must be described by the designated UST operator in Section 3. <br /> Page 2 of 4 <br /> Lydia Baker, SR. REHS Page 1 of 2 <br />