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ar►k Report <br /> storage l 5 eCbon <br /> d p <br /> �ndergr°unorVjSUa��n .on 3. <br /> tot <br /> S 'tion <br /> ted\3S1 Open , p A�'fI�N Ssves from ec <br /> Oes�gna FOLLOW U mP(iance I <br /> �OPERp>;�R pES <br /> CR1PTtON�� appropriate°° <br /> to correspon <br /> d to <br /> ��bst the follow up action <br /> 1 <br /> s. OWNER I OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTS <br /> 1lhavereviewedthe results of the designated UST operator inspection report and provided a <br /> description of the action(s)taken or to betaken to correct any compliance issues discovered. <br /> Name of US caner I Operator(print) <br /> USZ Ownerl p rator Signature <br /> Date Signed <br /> 1. INSPECT N HISTORY j` Z J " Z <br /> l,as each follow-up acfion of Section 3 from the <br /> Operator Inspection Report been <br /> Attach documentation Port e completed a Previous Designated UST <br /> S. RELEASE appropriate appropriately? <br /> hr E DETECTIO service to this re Yes NO NA <br /> Anach a co N ALARM HI port. <br /> � PY of the alar STORY � ❑ <br /> I is the monitorin m history re <br /> Has each ala 9 system Powered o por[/log to this re <br /> CE (Ah8ch d si the n an <br /> °C°rentato Previous ins din proper oiler port. <br /> 14 Have all 00 nver�(yin pection atirl m0 <br /> dei rent 9 appro been resp, de? YeS <br /> �Mcet UST <br /> 0Perator- at have hadservicet tSdedtoappro N0 NA <br /> Allanswe�ra tion rep0n been since report.) prlately? <br /> "red°No„mustbe res to by ai�us 0 <br /> describe qualified <br /> d by the aest9h <br /> ated UST°pe 4 <br /> rat0r�h <br /> seef'ah <br /> 3 <br />