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' '�y _xi_ 1. w � 'y, 't :i�+�' �. r.=t`' .8 r- <{.f t r'�7' ,tw f. y j`r... aG.a :L•.'�.:�.' ,•ac •sN` k� A��crr. <br /> Underground Storage Tank <br /> w Designated UST Operator Visual Inspection Report <br /> 5. OWNER/OPERATOR DESCRIPTION OF FOLLOW=UP ACTION <br /> Number the follow up actions to correspond to appropriate COmpiiance issues from Section 3. <br /> 5. 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/ r or Signature Date Signed <br /> 7/15/2022 <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 von-Aying qppropriate service to this report.) <br /> 8. RELEASE DETECTION ALARM HISTORY <br /> Atfach a copy Of the alarm history reportAog 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'? <br /> All answers marked"NO"must be described by the designated UST operator in Section 3: q <br /> I <br /> Page 2 of 4 <br /> ■ <br />