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V <br /> storage Vr'K tion Report c <br /> hated Uc <br /> nderq�o�� �5�alln pes�g <br /> Brat TION s TZf%0N <br /> ST Op p� <br /> gated L LLOW.UP liance issues from Section 3 vST SYSTEM, gectlon 3 all <br /> peslq Sinate <br /> CRIPTION d of ppropriate comp �Ist bel0e and ious Oetcte tech <br /> T09 DE son ce the p d sere <br /> to rep Sin e,Wate <br /> oPE� cor a qualified <br /> N OWNER/ u actions to by nmesump fre <br /> follow p rl for da., <br /> Number the inspectjO <br /> the c°nta� 1D <br /> Is ent Sump <br /> LLEAR <br /> Co <br /> m <br /> 1[t <br />�' A✓'Rr wo 5 <br /> ens a1�s o P°�Un�tyr? <br />"NR�'E,II ttL t«ate" the eacl�es smtain en <br /> Is the spills{°ctions? Is <br /> free of ob ta\�ment\D <br /> gpi\\C°n <br /> •r��w� ucKet-B, <br />,n COLL2,t. SP\\\6 <br /> MSVC�`N aft 1 <br /> I`RaYE�WR � GKet-9 <br /> urtAU„[0.0.UA <br /> aAIaaDRwet-vies e <br />'�R�LSPS\\Bue <br /> "� s. OWNER t OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTS <br />�N(Ra ERMUR <br /> RalNTER ERa U, <br />�uY NE,�F.' I have reviewed the results of the designated UST operator irlSpeCttOn report an provided a <br /> N1' description of the action(s)taken or to be taken to correct any compliance issues discovered. <br /> �Y N� UDC freE <br /> Name of UST Owner/Operator(print) is the U <br /> °a"t:Y� re <br /> detect a <br /> rArPR�" UST Owner/Operator Signature Date Signed <br /> \3C\D <br /> rR NTL <br /> ruRTE D <br /> vnrEa a PIi <br /> D\seegel n <br /> P0.lNTE <br /> 7. INSPECTION HISTORY <br /> Pa1NIt <br /> oRN seg-• <br /> Has each follow-up action of Section 3 from the previous Designated UST Yes No in NA D�SPen D\sP <br /> (AttaOperator Inspection Report been completed appropriately? e,150 <br /> ch documentation veri fY 9 pp p a ro riate service to this report.) ❑ ❑ s< <br /> S. RELEASE DETECTION ALARM HISTORY D`spen <br /> Attach a copy of the alarm histo D\sPen' <br /> Is the monitoring system powered on andoi�prp to this report, <br /> Yes No NA D\spe <br /> Has each alarm since the previous ins p operating mode? <br /> (Attach documentation verifying inspection been res H ❑ D+sp <br /> Have all containment sum appropriate se responded to appropriately? <br /> ps,that have had service t0 this re <br /> designated UST o an alar poi.) ❑ ❑ <br /> service technician? <br /> inspection re m Since the <br /> p0�� been resp°nded to by <br /> by a qualified <br /> All answers u ❑ ❑ <br /> NND3 marked No"must be described <br /> by the designated UST operator <br /> er <br /> p ator to Section 3. <br /> DELIVERY HE DED CLEAR /� 4 <br /> DELIVERY ERROR CLEAR 21_0 t-- Co e / O 4 INTER Pa('�G L. <br /> CLFAR 21-01-23 9:03 `J' <br /> PAPER ODI LLEAR 21-01-23 <br /> PAP,,N IaROa CLEaR 2101-23 9'.03 3 <br /> e'INTER ERROR LL`r_ 2U o1_231i ao MISC-3443CHER-03128/202 <br /> PAPER Ottr CLEAR 20 01-23 8:02 <br /> DELNERY NEEDEO CLEAR <br /> iE1 DELIVERY NEEDED ql arm History <br /> Page 4 - <br />