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TO <br /> I <br /> II <br /> II <br /> I <br /> i <br /> --�� I, 6 . OWNER I OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTS <br /> -�I II I have reviewed the results of the designated UST operator inspection report and provided a <br /> --HEWREBYESY I ` I description of the action (s) taken or to be taken to correct any compliance issues discovered. <br /> I <br /> 13 PLACED II Name of UST Owner / Operator (print) p <br /> A <br /> , UST Owner/Operator Signature <br /> QTV Date Signed <br /> 11 / 18/2022 <br /> i 7 . INSPECTION HISTORY <br /> Has each follow-up action of Section 3 from the previous Designated <br /> Operator Inspection Report been completed appropriately? g d UST Yes No NA <br /> 1 Attach documentation veri in ✓ <br /> a <br /> r <br /> o r" ❑ <br /> gate sere ' ❑ ❑ <br /> 8 • RELEASE DETECTION ALARM HISTORY ice to this re ort <br /> I Attach a co <br /> py of the alarm history report//o <br /> Is the monitoring system 9 to this report Yes No NA <br /> Has each powered on and in proper operating mode ? ❑✓ ❑ <br /> (Attach alarm since the <br /> do previous inspeCtion been responded to <br /> Have mentation verifying a appropriately? ✓ <br /> ali containment su appropriate service to this report ) ❑ ❑ ❑ <br /> � desi <br /> 9nated UST o mpg , that have had an alarm tec Aerator inspection re since the Previous <br /> 4 . <br /> �7 hnician? port, been responded to by a qualified ❑ ❑ © <br /> ' All <br /> 1' en ►narked uNo .yrI <br /> must be d <br /> escribed by the desion;Qf, 1 � r <br />