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UST EQUIPMENT MONITORINGOG <br /> Facility Number: Chevron # Month/Year: <br /> Equipment: VEEDER-ROOT TLS 350 <br /> Equipment <br /> Date Operational? Alarm Status 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 0 <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(e.g., buzzer sounds, red lights on, etc.), or if you have other reasons to suspect a leak(e.g., unusual system <br /> occurrences, etc.), you must investigate and track your activities using the "Suspected Leak Activity Log". <br /> • If the equipment malfunctions(e.g., green lights not on, lost power, etc.), or for cathodic protection systems that are not operational or <br /> show abnormal stats, contact Chevron Maintenance Dispatch. <br /> Chevron Review(Name/Signature Date: <br />