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U EQUIPMENT MONITORING*G <br /> Facility Number: Chevron Station# Month/Year <br /> Equipment: VEEDER-ROOT TLS-350 <br /> Date Equipment Alarm Status <br /> Operational? O.K.? Comments Initials <br /> 01 Yes ❑ No ❑ Yes ❑ No ❑ <br /> 02 Yes ❑ No ❑ Yes ❑ No ❑ <br /> 03 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 ❑ <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 /> E330 Yes ❑ No ❑ Yes ❑ No ❑ <br /> 1 Yes ❑ No ❑ Yes ❑ No ❑ <br /> • In the case of alarms,(audible alerts,warning and alarm system lights),system failure,tear off the Alarm Condition Report <br /> printout from your monitoring system and document the alarm condition under the appropriate category listed above.Using the <br /> Suspected Leak Activity Log,track your activities until"All Functions Normal"is displayed on the monitoring system console. <br /> Retain all alarm condition test reports and repair work orders related to each alarm. <br /> File the completed log with the UST Inventory Reconciliation Logs in the"Underground Storage Tank"Section of your station's <br /> Retail Facility Compliance Workbook. <br /> Chevron Review (Name/Signature) Date: <br /> SJCEHD-d(07/03)-5/8 07/23/03 <br />