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c <br /> 1 <br /> No. TESTI �esi9hat <br /> 12 S �onit N�' <br /> AN <br /> eq 11STaergroUha <br /> rt <br /> Ila,,III- ohths?r�ry9 SY' MAINT� Operator Visual ns Storage Tank <br /> Rep° {e last <br /> c to N N a <br /> p D <br /> Has o thS-,) Iner certipica CE N° NA pert°rmed3 <br /> the OVI , rf 11 teStin °n beep Yes 0:3-07-2p2 <br /> Has 316 36 rrl) entio Prevg be cord cOmpleteq within the past ❑ 2023 <br /> 07' <br /> Ha rt)onth,g8ry�toh? ry e4Uipr�eht Ih pieteq Within the past ❑ 0 <br /> 3 <br /> I--tearn tlghtnes t8iry�eht testih Spectioh b(,en completed within ❑ ❑ 0312022 <br /> ti Irk s line tight S testing beep g been cempieted within the past ❑ ❑ 07-07-2021 <br /> p <br /> OtherrT es? Hess testing be <br /> completeq Within required <br /> est/M ry corn ❑ ❑ <br /> Other ainte pleteq Within q <br /> r Test/ trance, the required ❑ ❑ �a <br /> Other Mainten �h <br /> NaF Test/I�ai ena nce ❑ ❑ ❑ Yyz <br /> ve ACtLtTY Ent nce. ❑ ❑ <br /> ern all indiv;dU MPLOYEE T 1-3 <br /> ❑ ❑ ❑ <br /> plOYee als pe RAINING Yes No <br /> ffor <br /> 13. CSM tra;n;n Within theins facility em <br /> 9 Wit � <br /> MENTg past 12 ployee duties received the required facility [ ❑ <br /> This sectio months? <br /> f deficiencies. maY be Used to record co <br /> mments or observations that are not current compliance <br /> 1 <br /> l <br /> "No"must be described bV the designated UST operator in Section 3. <br /> answers Marked <br /> Page 4 Of 4 <br />