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¢ Designated UST Operator Visual Inspection Report <br />�,5. OWNERIOPERATOR DESCRIPTION OF FOLLOW-UP ACTION <br />I Number the follow up actions to correspond to appropriate compliance issues from Section 3. <br />Y1Vo-Q <br />� <br />1i6. 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 action(s) taken or to be taken to correct any compliance issues discovered. <br />PName of UST Owner/ Operator (print) C-1W�n/ <br />UST Owner/Operator Signature <br />Date Signed 4 <br />7. INSPECTION HISTORY <br />Has each follow-up action of Section 3 from the previous Designated UST <br />Yes <br />No <br />NA <br />Operator In spection Report been completed appropriately? <br />❑ <br />❑ <br />Cly <br />Attach documentation verifying appropriate service to this report.) <br />8. RELEASE DETECTION ALARM HISTORY <br />Attach a copy of the alarm history report4og to this report. <br />Yes <br />No <br />NA <br />Is the monitoring system powered on and in proper operating mode? <br />❑ <br />Has each alarm since the previous inspection been responded to appropriately? <br />❑ <br />❑ <br />(Attach documentation verifying appropriate service to this report.) <br />Have all containmentsumps, that have had an alarm since the previous <br />designated UST operator inspection report, been responded to by a qualified <br />❑ <br />❑ <br />L7 <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 />