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. �Pilot/ Flying J - Lodi #617 V . of #ZRNxoREhS0r Dailv UST ®ni nq Slystem Check Form Rev. * AFN = ALL FUNCTIONS NORMAL (no current 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 "AFN' 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 "If fn Alarm, Screen Reads:" column. Complete the separate UST System Alarm Response Loci 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. a ❑ pm EfSiren OK All bulbs light rfnterworks ElOn-going alarm(s) 2 am ❑ pm ren OK I bulbs light Inter works ❑ On-going alarm(s) 3 5LI7 Ham ❑ pm ®"Siren OK .H All bulbs light U'Printer works @AFN* ❑ On-going alarm(s) 4 ,Q am ❑ pm _-2-Siren OK _[Ml bulbs light 0"Printer works ❑ * ❑ On-going alarm(s)1105 5 cj •,��j lTa-m ❑ pm J:2 -Siren OK e0'All bulbs light .0 isrinter works • 01tFN* ❑ On-going alarm(s) 6q4m ❑ pmiren OK P4Fbulbs lightInter works N* ❑ On-going alarm(s) 7 ,121 -am ❑ pm Siren OK •AU'bulbs light ._ -aR inter works AFN* ❑ On-going alarm(s) 8 aT ❑ pm ren OK Q.><Yfl lbs light 4ErPr1ntr works * ❑ On-going alarm(s) 9am ❑ pm en OK I bulbs light rinter works * ❑ On-going alarm(s) 10 ❑ am CIpm en OK C ttbulbs light C1-Kiinter works I "AFN* - ❑ On-going alarm(s) _ 11 � Naar 13pm Siren OK 1 bulbs light O'�rinter works N* ❑ On-going alarm(s) 12 t -j'. Ck) m ❑ pm ,Rtren OK 1,341 bulbs light ,, rArinter works N* ❑ On-going alarm(s) 13 plim ❑ pm ,-'Siren OK E3.,Wbulbs light IIPMter works FN* ❑ On-going alarm(s) _ 14 m ❑ pm Siren OK .•0111 bulbs light -0 printer works -ErKFN* ❑ On-going alarms) 15 ;' -.,E3--am ❑ pm E7'Siren OK SII bulbs light -43?rinter works .-El-AFN* ❑ On-going alarm(s) 16 ii m ❑ pm J2, en OK _L -.1 -All bulbs light _ D4*nter works * ❑ On-going alarm(s) 17 14.2m apm Siren OK O Ait bulbs light 0 -Printer works Q-Af N* ❑ On-going alarm(s) 18 Glaim ❑ pm C -.Men OK [3-All"bulbs light U -Printer works FN* 0 On-going alarm(s) ` .._.._.r 19 m ❑ pm Ian OK bulbs light mer works -0,AFN* ❑ On-going alarm(s) 20 Lx) JQIA ❑ pm iren OK fa Alibulbs light -0 Printer works _Q-AFN* ❑ Ort -going alarm(s) 21 F �ala ❑ pm men OK -9-All bulbs light Printer works j1AFN* ❑ On-going alarm(s) 22 am ❑ prtr •:e'Siren OK J2r91l bulbs light -0-Printer works N* ❑ On-going alarm(s) 23 i a �m ❑ pm siren OK bulbs light M -Printer works ❑ On-going alarms) 24 jo,} am ❑ pm earen OK 13 All bulbs light 0 -Printer works I ®11FN* ❑ On-going alarm(s) 25 ❑ am ❑ pm ❑ Siren OK ❑ All bulbs light ❑ Printer works ❑ AFN* ❑ On-going alarm(s) 26 ❑ am ❑ pm ❑ Siren OK ❑ All bulbs light ❑ Printer works ❑ AFN* CI On-going alarm(s) 27 ❑ am ❑ pm ❑ Siren OK ® All bulbs light ❑ Printer works ❑ AFN* ❑ On-going alarm(s) 28 29 ❑ am ❑ am ❑ pm ❑ pm ❑ Siren OK ❑ Siren OK _ ❑ All bulbs light ❑ All bulbs light ❑ Printer works ❑ Printer works ❑ AFN* ❑ AFN* ❑ On-going alarm(s) ❑ On-going alarm(s) 30 ❑ am ❑ pm ❑ Siren OK ❑ All bulbs light ❑ Printer works ❑ AFN* ❑ On-going alarm(s)_ 31 ❑ am ❑ pm ❑ Siren OK ❑ All bulbs light ❑ Printer works ❑ AFN* 0 On-going alarm(s) * AFN = ALL FUNCTIONS NORMAL (no current 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 "AFN' 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 "If fn Alarm, Screen Reads:" column. Complete the separate UST System Alarm Response Loci 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.