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Wo"�I�MU Pilot/Flying J- Lodi#617- Veeder..-jot#Y nr,•urx�ur�wro••u� Daily AST Monitoring Check Form • s�� - (� Rev.08/14/2010 Date Time Daily MonitoringAlarm, • 1 i63D ❑ pm Siren OK Ail bulbs light ter work N* ❑On-going alarms) 2 m ❑ pm Siren OK All bulbs light s N* ❑On-going alarm(s) 3 m ❑ pm iren OK/ I bulbs light Printer works FN* ❑On-going alarm(s) a 4 ❑pm' iron OK All bulbs light rinter works AFN* ❑On-going alarm(s) 5 am ❑prn ire0 OK bulbs light Printer works AFM* ❑On-going alarm(s) 6 m ❑ pm ireOK bulbs light rinter works FN* ❑On-going alarm(s) 7 m ❑prnSiren OK I bulbs light Vrinter works AFN* ❑On-going alarms) 8 rp ❑pm irqp OK I bulbs light riter works AFN* ❑On-going alarm(s) 9 am ❑pm iren OK All bulbs light rinter works AFN* ❑On-going alarm(s) 10 <�'h ❑am n OK - albs light rinter works AFN* ❑On-going alarm(s) A 11 0 ❑am m en OK ,p-AII bulbs light Winter works N* ❑On-going alarm(s) TT 12 "t ❑am � 0,6iron OK bulbs light er works * ❑On-going alarm(s) 13 Cl am ren OK bulbs light 'GW- works `AFN* ❑On-going alarm(s) 14 ,I7 am ❑pm iren OK Q-AWbulbs light B`Mnter works .C1 AFN* ❑On-going alarm(s) 15 alarrl ❑pm OTiren OK J2-Afbulbs light Inter works ,fI`N* ❑On-going alarm(s) 16 m ❑pm ,iren OK II bulbs light A31:1dnter works * N* ❑On-going alarm(s) 17 ❑am m rAMiren OK , All bulbs light >EtPrinter works AFN* ❑On-going alarm(s) 18 13 am ren OK bulbs light "nter works N* ❑On-going alarms) 19 Vajn ❑pm iren 0 11 bulbs light inter works A AFN* ❑On-going alarm(s) 20 ❑pm kairon OK W11 bulbs light rinter works 0 AFN* ❑On-going alarm(s) 21 ❑p PSiron OK II bulbs light inter works A AFN* ❑On-going alarrrl(s) 22 -J ann ❑pm IV Siron OK I bulbs light rinter works 44EW ❑On-going alarm(s) 23 am ❑pmiren OKII-bulbs light nter works N* I _On-going alarm(s) 24 "� am ❑pm Siren OK All bulbs light APrinterworks N* ❑On-going alarm(s) 25 am ❑pm A Siren OK ll bulbs light nter works FN* ❑On-going alarm(s) 26 am ❑p iren OK I bulbs light P inter works FN* ❑On-going alarm(s) 27 am ❑pm iren OK bulbs light ANnter works N* O On-going alarm(s) 28 am ❑ pmSiren OK bulb fight rinter works FIV* 13On-going alarms) _ 29 am ❑pm Siren OK As lig#rlt ATVer works * ❑On-going alarm(s) - 30 ❑pmI n OK It bulbs ligtjt rinter works AFN* ❑On-going alarm(s) 31 ❑am ❑pm Siren OK ❑All bulbs light ❑ Printer works AD AFN* ❑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,the the "AFM box. If an alarm is occurring at the tirpe of the daily MS test,check the"Orr-going Alarm(sr box and record the sensor ID(s)and the alarm panel screen reading(s)under the"If in Alarm,Screen Reads'column.£smptetethe separate UST System Alarm Response Loo for each MS environmental alarrn 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.