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Underground Storage Tank <br />Designated UST Operator Visual Inspection Report <br />All answers marked “No” must be described by the designated UST operator in Section 3. <br />Page 2 of 4 <br />5. OWNER/OPERATOR DESCRIPTION OF FOLLOW-UP ACTION <br />Number the follow up actions to correspond to appropriate compliance issues from Section 3. <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 / Operator (print) <br />UST Owner/Operator Signature Date Signed <br />7. INSPECTION HISTORY <br />. <br />Has each follow-up action of Section 3 from the previous Designated UST <br />Operator Inspection Report been completed appropriately? <br />(Attach documentation verifying appropriate service to this report.) <br />Yes No NA <br />8. RELEASE DETECTION ALARM HISTORY <br />Attach a copy of the alarm history report/log to this report.Yes No NA <br />Is the monitoring system powered on and in proper operating mode? <br />Has each alarm since the previous inspection been responded to appropriately? <br />(Attach documentation verifying appropriate service to this report.) <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?