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Underground Storage Tank <br /> Designated LIST Operator Visual Inspection Report <br /> 5. OWNER/OPERATOR DESCRIPTION OF FOLLOW-UP ACTION <br /> Number the follow up actions to correspond to appropriate compliance issues from Section 3. <br /> tt <br /> 6. OWNER OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTS <br /> ------------ ------ <br /> I have reviewed the results of the designated UST operator inspection report and provided a <br /> description of the action(s) taken or to be taken to correct any compliance issues discovered <br /> Nam&-S�Swne "r or ( tint) <br /> UST O_wp4r/Qperator Si ature Date igned <br /> LINSPECTION HISTORY Y ���� <br /> Has each of Section 3fron the previous Designated YesTNo N <br /> Operator Inspection Report been completed appropriately? <br /> (Attach documentation verifying appropriate service to this report. <br /> L <br /> 18. RELEASE DETECTION ALARM HISTORY <br /> Attach a copy of the alarm history reportliog to this report. Yes/ No NA <br /> Is the monitoring system powered on and in proper operating mode? <br /> Has each alarm since the previous inspection been responded to appropriately? <br /> (Attach documentation verifying appropriate-service to this report.) <br /> Have all containment sumps, that have had an alarm since the previous <br /> designated UST operator inspection report, been responded to by a qualified <br /> service technician? <br /> All answers marked "No" must be described by the designated UST operator in Section 3. <br /> Page 2 of 4 <br />