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v zT _ CI) (D <br /> 0 0 O zt <br /> 0 0o G <br /> ONv <br /> N Q �# N (D <br /> O T) <br /> _ — D <br /> rn v o <br /> = (D U) <br /> Underground Storage Tank m <br /> 0 <br /> Operator Visual Ins o <br /> Designated UST O <br /> p Inspection Report m m <br /> r- <br /> o <br /> pyVNEIZ/OPl:1ZATOR DESCRIPTION of FOLLOW-UP ACTION - C-)uj �r the follow up actions to correspond to appropriate compliance issues from Section 3. lD <br /> N <br /> 0 <br /> O O <br /> CnCn <br /> � C <br /> C <br /> C9 <br /> N <br /> O v <br /> 1 � N <br /> C r <br /> cQ' 73 <br /> (D m <br /> m <br /> C2. Q <br /> C) <br /> v <br /> m <br /> o D <br /> _0 o <br /> cn <br /> o <br /> b. OWNER/OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTS O <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. 00 <br /> Name of UST Owner/Operator(print) — <br /> Vikas Patel o_ <br /> UST Owner/Operator S€gnature N <br /> d1.,i Date Signed � <br /> — 9/30/2021 <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 ver' in a ro riate service to this re ort. <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? 0 <br /> Has each alarm since the previous inspection been responded to appropriately? x <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 x <br /> service technician? <br /> All answers marked'Noe must be described by the designated UST operator in Section 3. 0 <br /> m <br /> 0 <br /> n <br /> Page 2 of 4 <br /> m � <br /> 0 <br /> 01 <br /> 0 <br /> jjjj� <br /> 0, <br /> w <br /> � v <br />