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Underground Storage Tank <br /> Designated UST Operator Visual Inspection Report <br /> 5. OWNERIOPERATOR DESCRIPTION OF FOLLOW-UP ACTION <br /> Number the follow up actions to correspond to appropriate compliance issues from Section _ <br /> 1. Retest scheduled. Awaiting permit. <br /> 6. OWNER ! OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTS <br /> I 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 f Operator (print <br /> Jashan C3I I <br /> UST Owner/Operator Signature Date Signed <br /> � �0 6/aoay <br /> T. INSPECTION HISTORY <br /> Has each follow-up action of Section 3 from the previous Designated UST Yes No NA <br /> Operator Inspection Repo been ccrnpleted appropriately? ❑ ❑ <br /> Attach documentation verifying appropriate service to this re ort_ <br /> 8. RELEASE DETECTION ALARM HISTORY <br /> Attach a copy of the alarm history reporMbg to this report. Yes No NA <br /> Is the monitoring systern powered on and in proper operating mode" 0 ❑ <br /> Has each alarm sinoe the previous inspection been responded to appropriately? <br /> (Attach documentation verifying appropriate service to this report_) 0 ❑ ❑ <br /> Have all containment sumps that have had an alarm since the previous <br /> designated UST operator inspection report, been responded to by a qualified ❑ ❑ <br /> service technician" <br /> Ait answers marked 'No"must be described by the designated US T operator in Section 3_ <br /> Page 2 of 4 <br /> 7-11 -41341 -09/06/2024 <br />