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Designated UST Operator Visual Inspection Report <br />5. OWNER/OPERATOR DESCRIPTION OF FOLLOW-UP ACTION <br />compliance issu es from <br />Numberthe follow up actions to correspond to <br />AM <br />17 <br />6. OWNER I 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 />Name of UST Owner/ Operator (print}'- itCa n .. - <br />USTOwnerlOperator Signature <br />Date Signed <br />7. INSPECTION HISTORY <br />Has each follow-up action of Section 3 from the previous Designated UST Yes No NA <br />Operator Inspection Report been completed appropriately. ❑ ❑ [� <br />Attach documentation vert in a ronate service to this report.) <br />8. RELEASE DETECTION ALARM HISTORY <br />Attach a copy of the alarm history reportllog to this report Yes No NA <br />Is the monitoring system powered on and in proper operating mode? Ur ❑ <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 />