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,rage <br />,fat the k <br /> Ae�tio �tiiorl <br /> iln Underground Storage Tank <br /> the pdSt , Designated UST Operator Visual Inspection Report a?ar5 <br /> t <br /> I� � <br /> 5. OWNER/OPERATOR DESCRIPTION OF FOLLOW-uP ACTION / <br /> teq Number the follow up actions to correspond to appropriate compliance issues from Section 3. r <br /> within at <br /> the t, ion <br /> ast rrm P' <br /> ,,Sta <br /> a� <br /> nta <br /> th e9ta <br /> 6. OWNER/OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTS <br /> to en <br /> 1 have reviewed the results of the designated UST operator inspection report and provided a <br /> description of the action(s) taken or to be taken to correct any compliance issues discovered. <br /> Name of UST Owner/Operator (print) <br /> UST Owner/Operator Signature Date Signed <br /> 7. INSPECTION HISTORY <br /> Has each follow-up action of Section 3 from the previous Designated UST Yes No NA <br /> Operator Inspection Report been completed appropriately? <br /> (Attach documentation veqLylng qppLopfiate sereport.) <br /> rvice to this <br /> 8. RELEASE DETECTION ALARM HISTORY <br /> Attach a copy of the alarm history report/log to this report. <br /> [designated <br /> the monitoring system powered on and in proper operating mode? Yes No NA <br /> as each alarm since the previous inspection been responded to appropriately? <br /> ❑ ❑ <br /> us <br /> ttach documentation verifying aice ❑ ❑ ❑ <br /> ve all containment sumps, t at have had an alarm s'his report.) <br /> UST operator inspection report, been responded to bynce the aloualifivice technician? Y qualified [] <br /> All answers marked "No"must be described by the designated UST operator P in Section 3. <br /> Page 2 of 4 <br />