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Appendix A <br /> Operator's Monitoring Report <br /> Submit a copy of the completed report to TAGG(L-633)of EPD <br /> through <br /> Month/Year Month/Year <br /> Equipment Test Log <br /> Once a year,the Operator must schedule maintenance testing and/or calibration of the electronic monitoring <br /> equipment. The Operator must attach the test report to this form after the testing is conducted. <br /> Date Tester <br /> Maintenance of interstitial space sensor <br /> Maintenance of magnetostrictive probe <br /> Maintenance of piping containment sump sensor <br /> Comments (i.e. visual observations): <br /> False Alarm Situation (If more than one false alarm occurs during the year, attach additional sheets <br /> or use the reverse of this form.) <br /> Responder: Date: _/_/_ Time: <br /> Describe what actions were taken to correct the problem: <br /> Operator's name(please print) Operator's signature Date <br /> This record must be kept for 5 years <br /> Monitoring and Response Program for 879-DlUl and 879-G3U1 11 of 14 <br />