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LOF PER TORS Pilot/Flying J-Lodi#617 Veedt, Root#Z `�'""'�""'°'""` UST *Stan Alarm Response Log Complete all sections that app The'Enl y t"box is to note the consecutive number d each en�y(If more than one is recorded in a month).The contrador ininrroation needs to be added only ti a contractor is called upon to resolve Rev.08/14/2010 the alarm.Check"Called in°if tis the case.Otherwise check•Selfnaged°Be sure to check the'Resolved"box when the condition triggering the alarm has been addressed.UMI then,the issue should be checked as"Per}ding° The goal of this form is to record environmental alarms plus their resolutions.Resolutions should be specific,such as'removed rainwater°a°replaced sensor rather than vague such as"told manager or'caned contractor.'If a contractorwork order provides more detail,be sure the record the work order#.Whoever completes an entry should note their name in the'Recorded V box.Write legibly and accurately and with enough detail to explain the alarm and the resolution without leaving out important details about the incident The space provided should be sufficient in most cases,but it is not,attach a separate piece of paper. Entry # Type of .nse Contractor Company • Order ❑Self-managed alled in Date Time Alarm Screen Reading, Incident Details and Initial Response Step(s) Taken R044ded B Date Time Follow Up Step(s) Taken to Resolve Alarm Trigger R' rded By: �: 3� P �,- a x4.0'ru C C lo Ie elf s s�� . n -f17 D 0 P �-CL ✓�-G - SL �Ik�t -i-/ t/—L uQ Cr~lrrent Status Cause of Was Product Released? /Comments and Further Actions Necessa ❑Pending solved 0 No release tained release ❑Uncontained release Entry # Alarm Response . Order ❑Self-managed ❑ Called in Date Time Alarm Screen Reading, Incident Details and Initial Response Step(s) Taken Recorded By: Date Time Follow Up Step(s) Taken to Resolve Alarm Trigger Recorded B Current Status Cause of Alarm Was Product Released? /Comments and Further Actions Necessary ❑Pending ❑Resolved ❑No release ❑Coptained release ❑Uncontained release Entry # Alarm ResponseCompany Order 4 Phone ❑ Self-msnaged ❑ Called in Date Time Alarm Screen Reading, Incident Details and Initial Response Step(s) Taken Recorded BY: Date Time Follow Up Step(s) Taken to Resolve Alarm Trigger Rlacorded B Cjurrent Status Cause of Alarm Was Product Released? /Comments and Further Actions Necessa El Pending M Resohed-- 173 No release 0 Contained release ❑Uncontained release