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UST E*IPMENT MONITORING <br /> Facility Number: Chevron Station# 201761 Month/Year <br /> Equipment: E - OOT TLS-350 <br /> Equipment Alarm Status O.K.? <br /> Date Operational? {All functions Normal) Comments Initials <br /> (Green Light On) <br /> 01 Yes ❑ Yes ❑ <br /> 02 Yes ❑ Yes ❑ <br /> 03 Yes ❑ Yes ❑ <br /> 04 Yes ❑ Yes ❑ <br /> 05 Yes ❑ Yes ❑ <br /> 06 Yes ❑ Yes ❑ <br /> 07 Yes ❑ Yes ❑ <br /> 08 Yes ❑ Yes ❑ <br /> 09 Yes ❑ Yes ❑ <br /> 10 Yes ❑ Yes ❑ <br /> 11 Yes ❑ Yes ❑ <br /> 12 Yes ❑ Yes ❑ <br /> 13 Yes ❑ Yes ❑ <br /> 14 Yes ❑ Yes ❑ <br /> 15 Yes ❑ Yes ❑ <br /> 16 Yes ❑ Yes ❑ <br /> 17 Yes ❑ Yes ❑ <br /> 18 Yes ❑ Yes ❑ <br /> 19 Yes ❑ Yes ❑ <br /> 20 Yes ❑ Yes ❑ <br /> 21 Yes ❑ Yes ❑ No ❑ <br /> 22 Yes ❑ Yes ❑ <br /> 23 Yes ❑ Yes ❑ <br /> 24 Yes ❑ Yes ❑ <br /> 25 Yes ❑ Yes ❑ <br /> 26 Yes ❑ Yes ❑ <br /> 27 Yes ❑ Yes ❑ <br /> 28 Yes ❑ Yes ❑ <br /> 29 Yes ❑ Yes ❑ <br /> 30 Yes ❑ Yes ❑ <br /> 31 Yes ❑ Yes ❑ <br /> • In the case of alarms,(audible alerts,warning and alarm system lights), system failure,tear off the Alarm Condition <br /> Report printout from your monitoring system printer and document the alarm condition under the appropriate <br /> category listed above.Using the Suspected Leak Activity Log,track your activities until"All Functions Normal"is <br /> displayed on the monitoring system console.Retain all alarm condition,test reports and repair work orders related to <br /> each alarm. <br /> O 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 />