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UCRL-AR-103194 <br /> Operator's Monitoring Report <br /> Submit to WATS Group (L-633) of EPD within five working <br /> days after the year <br /> Yearly Period <br /> through <br /> Month/Year Month/Year <br /> Equipment Test Log <br /> Once a year the Operator must schedule maintenance testing on the electronic monitoring <br /> equipment. The Operator must attach the test report to this form after the test is conducted. <br /> Date Tester <br /> Maintenance of tank annular-space leak detector <br /> (liquid-level indicator): _/ J— <br /> Maintenance of piping annular-space leak detector <br /> (hazardous-substance sensor): <br /> False Alarm Situation (If more than two false alarms occur during the year, attach additional <br /> sheets or use the reverse of this form.) <br /> Responder: Date:__j _J_ Time: <br /> Describe what actions were taken to correct the problem: <br /> Responder: Date:__jj Time: <br /> Describe what actions were taken to correct the problem: <br /> Operator's name (please print) Operator's signature Date <br /> Call WATS Group for additional forms (423-7417) <br /> C-2 Monitoring Program for New Underground Storage Tank <br />