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Underground storage k <br />Designated UST Operator Vis <br />ual <br />ins P c;tion Report <br />_ - <br />S. hfERl kA--TOR DEsORIPTION OF FOLLOW-UP ACTION <br />ember the €olrow sCtior+s to correspond to appropriate con'pliance Issues from ection . <br />i <br />5 OWNER i OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTS <br />1 have reviewed the results of the des6ni ated LAST operator inspection report and provided a <br />description of the action(s) taken or to be taken to correct any compliance issues discovered. <br />tVarne of UST Owner { Operator {prints �� <br />UST Owner/Operator Signature Date Signed <br />7. INSPECTION HISTORY <br />Ias eaci� Foilo +-up aot�an of Section 3 roan the prey ous Designated UST <br />Operator Inspection Report been completed appropriately? Yes No IVA <br />Attach dccufne171at'Ot� ver6ling a M ro r�afe ervice to this ,Sac) <br />rt, ❑ LF! — <br />S. RELEASE DETECTION ALARM HISTORY <br />Attach aopY Of the alarm hr'sory reportlfag to I <br />17 report. <br />1s the monitoring system powered on and in proper o e —�— �_ Yes No N <br />p rating mode" ] <br />Has each alarm since the previous irEspection been responded to aPDfapriateiy? <br />(Alta r docurne,71a ion vedlying appmpriate s&rvfce a )17rs report.) <br />Ij <br />Have ail containmer-t sumps. that have had art alarm since t#; previo� <br />designated UST operator [rispection report, been (espoIded to by a qualified <br />service(L-rhnidan 0 1 � <br />A// answers marked "No" must be described by fhe deslgnated UST epera fQr in Se0or1 3 <br />. %Z2 <br />Pag6 2 of 4 <br />