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pAissues from Secs. des <br /> I n� ti n ser <br /> POW /per ae complia e o <br /> to ePP��P�ia <br /> �aESLR��n,,d <br /> to <br /> slf+ e/tBrl <br /> _�ypraltgB F <br /> Is <br /> C <br /> S <br /> c <br /> / <br /> t <br /> i� <br /> vERioPERAT°R ACKNOWLEDGEMENT OF INSPECTION RESULTS <br /> inrvereviewed the results of the designated UST operator inspection repo <br /> descrlptton of the actions)taken or to be taken to correct any compliance i� u d v <br /> Name of UST Owner/Operator(print) issues prO 1 <br /> John Kluenker Ues dis°oV�dd <br /> UST 01vner/0 ria <br /> Aerator Signature <br /> Date Signed <br /> 7. INSPECTION HISTORY 10117121 <br /> Has each follow- <br /> _ oda�r Ins up actport been <br /> 3 from the <br /> Inspection Re previous Desi <br /> d°cementation very een completed 9'nated UST <br /> 8. RELEASE mg appropriat appropriately? <br /> DETECTIO e service fo this re Yes <br /> Attach a co N ALgRry1 HISTORY pOlt) ® No NA <br /> pY of the alar <br /> Is the monitorin m histo O <br /> Has each alarm9 system powered <br /> Mand 'repo�/og to this repo <br /> (Attach since the n proper <br /> d0cementation ve°/evious inspection b °peratin9 Mode? Y <br /> All answersee es <br /> No„ n9appropr/ate se nto Spon d N0 NA <br /> mar>fed„ be nice fh/s dee to appr0pria� ® ❑ <br /> must port el y? <br /> descr.660(b y the ae <br /> 1 s�q,�atea QST ® ❑ � I <br /> °Aerator in Secti <br /> on 3 <br /> Page 2 of 4 <br />