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16 East Harding Way PR0231136 <br /> February 15, 2022 Program: UST <br /> PHOTO 2: 7/1/2021 DO re ort not dated b Owner/Operator. <br /> l" <br /> S� <br /> f <br /> _ D <br /> 30 <br /> r <br /> 2 On <br /> 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 3. <br /> T A TEST <br /> 6. OWNER/OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTS <br /> have reviewed the results of the designated UST operator inspection reportand provided a <br /> description of the actions)taken or to be taken to correct any compliance issues discovered. <br /> Name of UST Owner/Operator(print) <br /> UST ner/Operator Signature <br /> Date Signed <br /> l <br /> 7. INSPECTION HISTORY <br /> No NA <br /> Has each follow-up action of Sectnio3 from the previous Designated UST Y❑ ❑ <br /> operator Inspection Report been completed appropriately? <br /> Attach documentation vedin apprDDriate service to this report.) <br /> 8. RELEASE DETECTION ALARM HISTORY <br /> Yes <br /> Attach a copy of the alarm history report/log to this report. <br /> No NA <br /> is the monitoring system powered on and in proper operating mode 1 ❑ <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 alar since the previous <br /> designated UST operator inspection report,been responded to by a qualified ❑ ❑ <br /> service technician? <br /> �l <br /> All answers marked°No"must be described by the designated UST operator in Section 3. <br /> Page 2 of 4 <br /> ri <br /> Lydia Baker, SR. REHS Page 2 of 4 <br />