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dPERATORS Pilot/ Flying J - Lodi #617 Vee&_ Root #1 <br />msoutxt•• CALIFOa•uk <br />AST System Alarm Response Log <br />Complete all sections that apply, The 'Entry #' box is to note the consecutive number of each entry of more than one is recorded in a month). The contractor information creeds to be added only If a contractor is called upon to resolve <br />the alarm. Check "Called in" if that is the case. Otherwise check "Self -managed' Be sure to check the 'Resolved' box when the condition triggering the alarm has been addressed. UnBI then, the tissue should be checked as "Pending." <br />The goal of this form is to record environmental alarms plus their resolutions. Resolutions should be specific, such as "removed rainwater" or "replaced sensor' rather than vague such as 'told manager" or `caned contractor." If a contractor work order <br />provides more detail, be sure the record the work order Al. Whoever completes an entry should note their nacre in the "Recorded By' box. Write legibly and accurately and with enough detail to explain the alarm and the resolution without leaving out <br />important details about the incident. The space provided should be sufficient in most cases, but If is not attach a separate piece of paper. <br />Entry # <br />MM <br />En_ <br />•-IM. •• • s • •, s3MITTV,• <br />D Self -managed D Called in <br />Date <br />Time <br />Alarm Screen Reading, Incident Details and Initial Response Ste s) Taken Recorded By: <br />dd <br />(, fig, L i . L-40P-PAVIM r .'s <br />ate <br />Time <br />Follow Up Step(s) Taken to Resolve Alarm Trigger Recorded By: <br />? 2 <br />f� <br />(JSJ�`eri r>A1A1vh <br />1. <br />0id5hr4- Vi; &,; lot- -Jam <br />Current Status <br />Cause of Alarm Was Product Released? /Comm nits and Further Actions Necessa <br />D Pending Wesolved <br />release D Contained release D Uncontained release <br />D Self -managed O Called in 77 <br />Date <br />Time <br />Alarm Screen Reading, Incident Details and Initial Res onse Ste s) Taken Recorded By: <br />Date <br />Time <br />Follow Up Step(s) Taken to Resolve Alarm Trigger Recorded By: <br />Current Status <br />Cause of Alarm Was Product Released? / Comments and Further Actions Necessary <br />D Pending D Resolved <br />❑ No release D Contained release D Uncontained release <br />