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1111 E. Kettleman, Lodi, CA 95240 PR0506724 <br /> 06/15/2022 Program: UST <br /> PHOTO 2: <br /> 3/3/2022 desi nated operator inspection report missing date owner/operator signed(page 2) _ <br /> Underground Storage Tank <br /> Designated UST Operator Visual Inspection Report j <br /> ---- - — <br /> 5.OWNERlOPERATOR DESCRIPTION OF FOLLOW-a a compACTIliance issues from Section 3. <br /> Number the follow up actions to correspond to app P <br /> i <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 /> 40 it Ij <br /> UST Owner/Op�ignature Date Signed <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 verifying appropriate service to this report.) E] R1 <br /> 8.RELEASE DETECTION ALARM HISTORY <br /> Attach a copy of the alarm history report/log to this report. <br /> Is the monitoring system powered on and in proper operating mode? Yes #NoNA <br /> Has each alarm since the previous inspection been responded to a(Attach documentation verifying appropriate servicetothis report.) ppropriately? ❑ <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? El 0 9 <br /> //answers marked"NO"Must be ryacr",; 4�...,_ <br /> VICKY VANG-LEE, REHS Page 2 of 4 <br />