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sitATORs Pilon/ Flying J - Lodi #617- Veer' of #1 OF SOUTIIENN CALIFONNIA Dailyfti Month: --- Year: im 1 L�lamC7 pm .'O�Siren OK O"AII bulbs light Wrinter works .: ❑ AFN* ❑ On going alarms) 2 ~ 13 ❑ pm ,C3#Siren OK -11AI ulbs light p Printer works -0 AFN* D On-going alarm(s) 3 ; �, '` am ❑ pm OSiren OK All bulbs light Tinter works AFN* ❑ On-going alarm(s) 4 er ❑ a 0 -pm Q .Siren OK CJ&UAmft"light ❑-Knter works G-AFN* ❑ On-going alarm(s) 5fjfj j ,s am ❑ pm 011&r'ren OK O-Airbulbs light CXPrinter works N* ❑ On-going alarm(s) �. _.." 6 <, ` am ❑ pm iren OK A!I albs light Center works ETAFN* ❑ On-going alarm(s) 7 - 17 am ❑ pm D"Siren OK 13"All bulbs light .-S-Printer works :--®-KFN* ❑ On-going alarm(s) 8 ; . t P -am ❑ pm ,.D Siren OK p A l bulbs light -D] Printer works . ®-0W ❑ On-going alarm(s) 9 j , t,. , Gleam D pm f! Siren OK C3'A11 bulbs light Gl Printer works ❑AFN* , ❑ On-going alarm (s) 10 am ❑ pm ren OK Rlkll bulbs light sinter works ❑ AFN* n going alarm(s) jt, -:IL � 11 ,"gym ❑ pm ..01iren OK :DAR bulbs light 13 -Printer works -,13-AFN* ❑ On-going alarm(s) 12 - Z- Clam 0 pm .H'Siren OK Q-Wbulbs light anter works 0-AFN* ❑ On-going alarm(s) 13 14 ❑ am ❑ am 0 pm ❑ pm ❑ Siren OK ❑ Siren OK ❑ All bulbs light ❑ All bulbs light ❑ Printer works ❑ Printer works ❑ AFN* . 0 AFN* ❑ On-going alarm(s) ❑ On-going alarm(s) 15 ,, Dam ❑ pm C] Siren OK 0 All bulbs light ❑ Printer works • ❑ AFN* ❑ On-going alarm(s) � `- f.: 16 Elam ❑ pm ETSiren OK 0 -All bulbs light ❑ Printer works _13 AFN* ❑ On-going alarm(s) - - 17 F ;;; • Ulm ❑ pm 0 Siren OK O. Ail bulbs light ❑ Printer works ❑ AFN* ❑ On-going alarm(s) 18 i.(j am ❑ pm Siren OK ILII bulbs light -2-P-tinter works * ® On-going alarm(s) I . 19 L4,%13 am Glpm iren OK LI -All bulbs light Cl,Pranter works N* ❑ On-going alarm(s) 20 "!0 '2 am ❑ pm Iren OK O.�t(�bulbs light ❑.Printer works * ❑ On-going alarms) 21 i `) C am ❑ pm Siren OK SII bulbs light nter works to-AFN* ❑ On going alarm(s) 22 `l ;O� am ❑ pm __,Siren OK gAftlbs light A.. -anter works CWFW ❑ On-going alarm(s) 23 `0< �Eram ❑ pm siren OK ,®-AMlbs light , � Printer works N* ❑ On-going alarm(s) 24 ; t✓ U ,tram O pmJ2-Siren OK I bulbs light _B -Printer works * ❑ On-going alarm(s) 25 am ❑ pm „Siren OK _PAfbulbs light Printer worksFN* ❑ On-going alarm(s) 26 1'6f 0-arh ❑ pm 01iren OK .G1.A1Pbulbs light ILPrinter works * ❑ On-going alarm(s) t, Y 59t4vp 1fr`,¢ t.�iiParnai ,' 27 c'1! - j i ,dam ❑ pm ERiren OK ❑,AII bulbs light Printer works ❑ On-going alarm(s) 28 ❑'am ❑ pm [3 Siren OK ❑ All bulbs light ❑ Printer works ❑ AFN* ❑ On-going alarm(s) 29 m ❑ pm .-3-Siren OK .J?"All bulbs light tinter works ❑AFN* �6rr going alarms) �3 ��,i _ 4bulbs 3p ; p ❑ pm ,iren OK Ail light Zl . inter works --❑ On-going alarm(s) 31 0 am ❑ pm ❑ Siren OK ❑ All bulbs light ❑ Printer works 0 AFN* ❑ On-going alarm(s) AFN = AU 1 UNG i I01Va P7uF[rVIAL trio cuneus alarms) Instructions: Press the alarm test button on the UST monitoring system (MS) and record the results under the "Daily Monitoring System Test Results" column. If there are no current alarms, check the WN' box. If an alarm is occurring at the time of the daily MS test, check the "On-going Alarm(s)" box and record the sensor ID(s) and the alarm panel screen reading(s) under the "/fin Alarm, Screen Reads." column. Complete the separate UST System Alarm Response Log for each MS environmental alarm noted (all alarms except "Paper Out" or "Fuel Delivery Needed'). Only a trained "Facility Employee" should complete this form or the Alarm Response Log. The FE should initial each entry made into this form using the last column.