Laserfiche WebLink
Underground Storage Tan <br /> Designated UST Operator Visual Inspection Report <br /> . WNERI PER T R DESCRIPTION OF FOLLOW-UP ACTION <br /> Number the follow up actions to correspond to appropriate compliance issues from Section 3. <br /> i <br /> I <br /> . OWNER f OPERATOR ACKNOWLEDGEMENT F INSPECTION RE ULT <br /> I have reviewed the results of the designated LIST 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 1 Operator pint <br /> T <br /> UST Owner/Operator Signature Date Sj ned <br /> .. <br /> 7. INSPECTION HISTORY <br /> Has each follow-up action of Section 3 from the previous Designated UST lies No N <br /> Operator Inspection Report been completed appropriately? <br /> (Attach documentation verifying ro rias r io �o ��iis report <br /> B. RELEASE DETECTION ALARM HISTORY <br /> Attach a copy of the alarm history report1log to this report. Yes No NA <br /> Is the monitoring system powered on and in proper operating mode? Q <br /> Has each alarm since the previous inspection been responded to appropriately � � ❑ <br /> (Attach do um ntation verifyiny appropriate service to this r pei -) <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 technic-Ian? <br /> All answers marked f'Na" must be described by the designated US T operator in Section 3. <br /> Page 2 of <br />