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USTCUIPMENT MONITORINROG <br /> Facility Number: Chevron Station#201761 Montli/Year <br /> Equipment; VEER ROOT TLS-350 <br /> Equipment Alarm Status O.K? <br /> Date Operational? (All functions Normal) Comments Initials <br /> (Omen Light On) <br /> 01 Yes ❑ No CJ Yes ❑ No 0 <br /> 02 Yea❑ No❑ Yes Q No ❑ <br /> 03 Yes Q No 0 Yes ❑ No ❑ <br /> 04 Yes d No ❑ Yes Q No ❑ <br /> OS Yes❑ No ❑ Yes 0 No ❑ <br /> 06 Yes❑ No U Yes 11 No ❑ <br /> 07 Yes ❑ No 0 Yes 0 No 0 <br /> 08 Yes❑ No 0 Yes 0 No Q <br /> 09 Yes 0 No ❑ Yes ❑ No❑ <br /> 10 Yes ❑ No 0 Yes ❑ No❑ <br /> 11 Yes❑ No 0 Yes❑ No 0 <br /> 12 Yes ❑ No ❑ Yes 0 No Q <br /> 13 Yes❑ No ❑ Yes ❑ No❑ <br /> 14 Yes ❑ No ❑ Yes ❑ No 0 <br /> 1s Yes 0 No ❑ Yes ❑ No❑ <br /> 16 Yes❑ No Q Yes d No ❑ <br /> 17 Yes 0 No ❑ Yes ❑ No❑ <br /> 18 Yes ❑ No❑ Yes❑ No ❑ <br /> 19 Yes❑ No 0 Yes ❑ No 0 <br /> 20 Yes 0 No ❑ Yes❑ No❑ <br /> 21 Yes 0 No ❑ Yes ❑ No ❑ <br /> 22 Yes II No ❑ Yes ❑ No❑ <br /> 23 Yes d No ❑ Yes❑ No Q <br /> 24 Yes Q No ❑ Yes ❑ No ❑ <br /> 25 Yes❑ No❑ Yes ❑ No Cl <br /> 26 Yes ❑ No ❑ Yes Q No❑ <br /> 27 Yes❑ No❑ Yee 0 No ❑ <br /> 28 Yes ❑ No ❑ Yes 0 No ❑ <br /> 29 Yes ❑ No 0 Yes 0 No p <br /> 30 Yes 0 No❑ Yes ❑ No Q <br /> 31 Yes❑ No❑ Yes❑ No❑ <br /> • e In the case of alarms,(audible al ,warning and alarm system lights),system failure,tear off Alarm Conditio <br /> ertsn <br /> Report printout from your monitoring system printer and document the alarm condition under the appropriate <br /> category listed above. Using the SnsplGftd Lmlike. ,track your activities until"All Functions Normal"is <br /> displayed on the monitoring systems console.Retain all a.lam condition,test reports and repair work orders related to <br /> each alarm. <br /> ® File the completed log with the UST Inventory Reconciliation Logs in the appropriate Month of your station's Retail <br /> Facility Compliance C)Management Workbook <br /> Manager Review(Signature) Date: <br /> ZTO Z VMIDV 0021 aD ZC90 ZZ5 M Yva U:ZT 600Z/ZZ/Zo <br />