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A <br /> a-z v. Y r� y �},� nr a� ! w1 �� ��y,.��'Yrr+r+Y•f� I('1�ie' <br /> A 1 _Oikt t (A 1j(A <br /> 6�''v <br /> � Y y• Fy � } y t, \ � t`� z t\,� �� y i t�!'.ry{ ri Y�'jll�` �A <br /> Underground storage Tank <br /> Designated UST Operator Visual Inspection Report <br /> TOR DESCRIPTION OF FOLLOW-UP ACTION 9. U <br /> 5. OWNERIOPERA ro riate compliance issues from Section 3. List <br /> actions to corespond to app P <br /> Number the follow up rsinc <br /> to b, <br /> insF <br /> Is th <br /> Gan <br /> Are <br /> the <br /> Is h <br /> Is ti <br /> SPI <br /> 6. OWNER/OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTS <br /> 1 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 Ow r Operator Signat re Dat Si ed Is <br /> q 8122 to <br /> >40 UI <br /> 7. INSPECTION HIS TRY <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.) <br /> 8. RELEASE DETECTION ALARM HISTORY Yes No NA <br /> Attach a copy of the alarm history reporblog to this report. <br /> Is the monitoring Y <br /> system powered on and in proper operating mode? ❑✓ ❑ <br /> in <br /> been responded to appropriately? <br /> Has each alarm since the previous ❑ ❑ ✓ <br /> riate service to this report.) <br /> (Attach documentation verifying appro p previous ❑ <br /> Have all containment sumps, that have had an alarm since thehto b a qualified ❑ <br /> designated UST operator inspection report, been responded y <br /> service technician? <br /> UST operator in Section 3. <br /> A//answers marked "No"must be described by <br /> the designated Page 2 of 4 <br />