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UST EQUIPMENT MONITORING LOG <br /> Chevron Station# 210997 Month/Year: <br /> Equipment: Veeder-Root TLS-350 <br /> Equipment Alarm Status O.K.? <br /> Date Operational? {All functions Normal} Comments Initials <br /> (Green Light On) <br /> 01 Yes ❑ No❑ Yes❑ No❑ <br /> 02 Yes ❑ No❑ Yes❑ No❑ <br /> 03 1 Yes ❑ No❑ Yes❑ No <br /> 04 Yes❑ No❑ Yes❑ No <br /> 05 Yes❑ No❑ Yes❑ No <br /> 06 Yes ❑ No❑ Yes❑ No <br /> 07 Yes ❑ No❑ Yes❑ No <br /> 08 Yes❑ No❑ Yes❑ No <br /> 09 Yes❑ No❑ Yes❑ No <br /> 10 Yes ❑ No❑ Yes❑ No <br /> 11 Yes ❑ No❑ Yes ❑ No <br /> 12 Yes ❑ No❑ Yes❑ No <br /> 13 Yes ❑ No❑ Yes❑ No <br /> 14 Yes❑ No❑ Yes ❑ No <br /> 15 Yes❑ No❑ Yes❑ No <br /> 16 Yes❑ No❑ Yes ❑ No 14 <br /> 17 Yes ❑ No❑ Yes ❑ No ❑ <br /> 18 Yes ❑ No❑ Yes ❑ No <br /> 19 Yes ❑ No❑ Yes ❑ No <br /> 20 Yes❑ No❑ Yes❑ No <br /> 21 Yes❑ No❑ Yes❑ No <br /> 22 Yes❑ No❑ Yes❑ No <br /> 23 Yes❑ No❑ Yes ❑ No <br /> 24 Yes❑ No❑ Yes❑ No <br /> 25 Yes❑ No❑ Yes❑ No <br /> 26 Yes❑ No❑ Yes❑ No <br /> 27 Yes❑ No❑ Yes❑ No <br /> 28 Yes❑ No❑ Yes ❑ No <br /> 29 Yes❑ No❑ Yes ❑ No <br /> 30 Yes❑ No❑ Yes❑ No <br /> 31 Yes❑ No❑ Yes❑ No <br /> In the case of alarms,(audible alerts,warning and alarm sy tem lights),system failure,tear off the Alarm Condition Report printout from your <br /> monitoring system and document the alarm condition unde the appropriate category listed above.Using the Suspected Leak Activity Log, <br /> track your activities until"All Functions Normal"is displayed on the monitoring system console.Retain ALL alarm condition reports and repair <br /> work orders related to each alarm. <br /> O FAX THE FIRST PASSING.I GPH LINE TEST FOR CALENDAR YEAR TO VEEDER-ROOT WITH COVER SHEET.RETAIN <br /> ALL other LINE TEST REPORTS in a file.File this forth,Veeder-Root Fax and LINE Test Reports with the UST Inventory Reconciliation <br /> Logs in die appropriate month section of your station's Ret ill Facility Compliance Workbook. <br /> Manager Review(Signature) Date: <br />