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Report 9rOnn s�ar InspV`iec[ion R,O_"I <br /> 011 tlp� Jnoe (at pLT10N <br /> ra° PeL se=fro., d5'0�POLLoW�e mmaoa les�e <br /> geJj5 t al N ss�es fro^' <br /> aaE p11O si9aala� npNOoaPPro <br /> UoA <br /> 0 Pdvpe N ap <br /> pP mPoene <br /> ago°,. p �S:R�sV°ne <br /> ,im o� fd�ea <br /> Pre 4. <br /> Pa n s o <br /> Ug1 �Pnafa __ .�,M rv. ..,. .. r <br /> 01 <br /> z nee ae <br /> ,,.,o,....... <br /> va- <br /> h� <br /> y 0 IOPERATORACKNOWLEDGEMENT OF INSPECTION RESULTS <br /> �'evraw'ed rheresuRsoffhe designated UST operator lnspECt100 report and <br /> RESULTS GT`GN rcUPeonoffeacoon(s)takenortobetakentocorrectanycompliance iSSUe, <br /> cfancew�h eaftof re afUSTOuner/O <br /> OWNER/OPERATOR ACKNDWLEDGEMEN7 DF INSPECTION peretor(print) <br /> talo(IDspeCtlon report .CERTIFICATION BY DESIGNATED UST OPEIUt�0oR 20Nb a^a NGnl Smatto^pfo Vhl`� <br /> ave reviewed the results of the designated UST ope eerttN that the visual insPchapterrl6 petlotmed m comp Aerator Sign fore <br /> Regulations,title 23,division 3, ahonReP°�P°oma <br /> :cription of the action(S)taken or to be taken to boned any C0111pt18flC8 IS ie in is pate mspa <br /> ve of UST Owner/Operator(print) rain is accurate. <br /> CC hated UST Aerator S' zt ovlarto2z �C770NN/STORY Date Sign <br /> Owner/Operator Signature IDO=\ntemaUonal CASA O° pec Up action of <br /> '.Dat% S stem, tl\manl, tion Section 3 fro <br /> ortln9 Y set Conte r <br /> j=Cali/omia Environmental RUDC=Under-Dispe '/entn e�n�en completed a e p ev'o <br /> NA=Not Applicable, DETECTIp /� a ropriate se pr0PrletelyDes 9nated <br /> �-- <br /> IPEC71 RYri nk Ili-ARMHIsr °lhic <br /> is.e_ QST <br /> yrv- D v xata,vsu. ,%., <br /> �r� zz a E°°ee>31tiNMhp ..o, <br /> I .�a em^ene avv°li9 a na ms>.q t f�252f ,..... <br /> {„W"✓ e °^o M°°°e:vela ai:vense°. term��e.ea agm4 ,..,. <br /> ew eria� <br /> ert <br /> rTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION <br /> rrival eparture ate aUmx�an certify that the visual inspection was performed in compliance with Calilomia Code <br /> 10.50 1130 121292 Bash.Ro�pen� ons,title 23,division 3,chapter 16,section 2716 and all inlormation provided <br /> sn e. <br /> tle Roden E <br /> gosh. Date Inspection Report Provided to Own <br /> `el 022 <br /> e Count ID <br /> NA=Not A ,,UST=UrAerground <br />