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SWrdge Tarek <br /> Desigraaed wT Aerator Vistud kwqmCWn Rem <br /> $- 0WNER )PERATOiR DFscRiRnm of FOLLaw�UP ACTION <br /> f Uv--kdov, to appMVIMO yes from Sects 3- <br /> rAEnt <br /> �awes fro oo�� <br /> O� INSPECTION RESULTS - a <br /> 1 6. OWNER I OPERATOR ACKNOWLEDGEMENT operator lnspecti� repot and pm�d <br /> i I have reviewed the results � signated UST compliance issues discovered. <br /> description of the actions) taken or to be taken'o correct an, <br /> Name of UST C)+ivr►er/Operator(.prig:} <br /> Date Signed <br /> UST for Signature 2/22023 <br /> 7. INSP ECTI HISTORY - Yes No NA <br /> Has each follow-up action of Section 3 from the previous Designated UST <br /> Y? 01 <br /> Operator Inspection Report been completed appropriate) — -- - <br /> Attach documentation verifdrna a ropriaCe service to this report.) _ <br /> 8. RELEASE DETECTION ALARM HISTORY Yes No NA <br /> re orfllog to this report. – --- ❑ <br /> Attach a copy of the alarm history p � <br /> nn system powered on and in proper operating mode? ❑ <br /> Is the monitoring Y '� <br /> Previous inspection been responded to appropriately. ❑ (] []✓ <br /> 11 Has each alarm since the P service to this report.) <br /> (Attach documentation verifying appropriate ❑ <br /> Have all containment sumps,that have r Cl to by a q alified <br /> designated UST operator inspection report, been <br /> service technician? - <br />�, � g 3. <br /> I! answers marked "No"must be described by the designated UST operator in Section <br /> A Page 2 of 4 <br />