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Underground Storage Tank <br /> Designated UST 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 /> 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 action(s) taken or to be taken to correct any compliance issues discovered. <br /> Name of UST Owner/Operator (print) <br /> ,J2.1ni S LU 1�'•Y V'i S <br /> UST �w r/Operattor-Signature Date Siggeel <br /> L Z_Z 7 ` <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 verifying appropriate service to this report) <br /> 8. RELEASE DETECTION ALARM HISTORY <br /> Attach a copy of the alarm history repor iog to this report. Yes No NA <br /> Is the monitoring system powered on and in proper operating mode? R1 ❑ <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 />