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undergroundStorage Tc <br /> nk <br /> Report <br /> UST operator Visual InSpCtion <br /> Designated <br /> p ACTION Section 3. <br /> OF FOLLOW- fiance issues from <br /> to correspond to appropriate comp <br /> --5. OWNEWOPERATOR DESCRIPTIO <br /> < action <br /> Number the follow up <br /> I <br /> 6. OWNER/OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTS <br /> Lve reviewed the results of the designated UST operator inspection report and provided a <br /> ription of the action(s)taken or to be taken to correct any compliance issues discovered. <br /> e of UST Owner/Operator(print). <br /> I UST Owner/Operator Sign ture Date Signe <br /> 7. INSPECTION HISTO Y �� <br /> Has each follow-up action of Section 3 from the previous Designated UST <br /> l Operator Inspection Report been completed appropriate) ? Yes <br /> Attach documentation verif in a appropriate riate service to this re ort. No N l <br /> 8. RELEASE DETECTION ALARM HISTORY ❑ E <br /> Attach a copy of the alarm history reporblog to this re <br /> Is the monitoring system powered on and in ro port. <br /> Has each alarm since the previous inspectiop been operating Yes No NA <br /> g mode? <br /> (Attach documentation verif in esponded to a El <br /> Have all containment sumps t�athave had priate service to the re ppr°priately? <br /> designated UST operator inspection re port) © E] <br /> 1 an alarm since the previous <br /> �service technician? port, been responded to by a qualified <br /> All answers marked" ✓[� <br /> No"must be desc�,.rjy the designated <br /> UST operator in Section 3 <br /> page 2 of 4 <br />