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Additional Notes: Inspector: Date: Complete the following if follow-up/corrective actions were identified during this inspection: Certified Completion of Follow-Up Actions: “I hereby certify that the follow-up/corrective actions identified in the inspection performed on _____________ (DATE) have been completed and any required maintenance deficiencies have been adequately corrected.” Inspector/Operator: Date: Page 8 of 8 Page 268 of 1174