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• EQUIPMENT • • !' t Facility Number: Chevron # Month/Year Equipment: VEEDER-ROOT TLS -350 Date Equipment Operational? Alarm Status O.K.? Comments Initials 01 Yes ❑ No ❑ Yes ❑ No ❑ 02 Yes ❑ No ❑ Yes ❑ No ❑ 03 Yes ❑ No ❑ Yes ❑ No ❑ 04 Yes ❑ No ❑ Yes ❑ No ❑ 05 Yes ❑ No ❑ Yes ❑ No ❑ 06 Yes ❑ No ❑ Yes ❑ No ❑ 07 Yes ❑ No ❑ Yes ❑ No ❑ 08 Yes ❑ No ❑ Yes ❑ No ❑ 09 Yes ❑ No ❑ Yes ❑ No ❑ 10 Yes ❑ No ❑ Yes ❑ No ❑ 11 Yes ❑ No ❑ Yes ❑ No ❑ 12 Yes ❑ No ❑ Yes ❑ No ❑ 13 Yes ❑ No ❑ Yes ❑ No ❑ 14 Yes ❑ No ❑ Yes ❑ No ❑ 15 Yes ❑ No ❑ Yes ❑ No ❑ 16 Yes ❑ No ❑ Yes ❑ No ❑ 17 Yes ❑ No ❑ Yes ❑ No ❑ 18 Yes ❑ No ❑ Yes ❑ No ❑ 19 Yes ❑ No ❑ Yes ❑ No ❑ 20 Yes ❑ No ❑ Yes ❑ No ❑ 21 Yes ❑ No ❑ Yes ❑ No ❑ 22 Yes ❑ No ❑ Yes ❑ No ❑ 23 Yes ❑ No ❑ Yes ❑ No ❑ 24 Yes ❑ No ❑ Yes ❑ No ❑ 25 Yes ❑ No ❑ Yes ❑ No ❑ 26 Yes ❑ No ❑ Yes ❑ No ❑ 27 Yes ❑ No ❑ Yes ❑ No ❑ 28 Yes ❑ No ❑ Yes ❑ No ❑ 29 Yes ❑ No ❑ Yes ❑ No ❑ 30 Yes ❑ No ❑ Yes ❑ No ❑ 31 Yes ❑ No ❑ Yes ❑ No ❑ • 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 occurrences, etc.), you must investigate and track your activities using the "Suspected Leak Activity Log". • If the equipment malfunctions (e.g., green lights not on, lost power, etc.), or for cathodic protection systems that are not operational or show abnormal stats, contact Chevron Maintenance Dispatch. Chevron Review (Name/Signature) Date: