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�'.'��n�h 4Jt:.�i 'S <br /> 1 iA v <br /> Y <br />.� 40 <br /> pesi Underground Storage Tank <br />_ gnated VST Operator Visual _ <br /> 5. OWNER/OPE Inspection Report <br /> Number BATOR DESCRIPTION <br /> the follow u OF FOLLOW-Up ACTION <br /> UP actions to correspond to appropriate compliance issues from Section 3 <br /> Qi6. OWNER/OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTS <br /> 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/Op or Signature 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 all"--date service to this report.) <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? ✓❑ ❑ <br /> Has each alarm since the previous inspection been responded to appropriately? ❑ 11 ❑ <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 /> f service technician? <br /> A#answers marked "No"must be described by the designated UST operator in Section 3. <br /> Page 2of4 <br />