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UST UIPMENT MONITORING L <br /> Facility Number: Chevron Station# Month/Year <br /> Equipment: VEEDER-ROOT TLS-350 <br /> Equipment Alarm Status <br /> Date Operational? 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 ❑ <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 /> O 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 and document the alarm condition under the appropriate category listed <br /> above.Using the Suspected Leak Activity Log,track your activities until"All Functions Normal"is displayed on the <br /> monitoring system console.Retain all alarm condition,test reports and repair work orders related to each alarm. <br /> Q File the completed log with the UST Inventory Reconciliation Logs in the"Underground Storage Tank"Section of your <br /> station's Retail Facility Com liance Workbook <br /> Chevron Review (Name/Signature) Date: <br />