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ARB Approved IOM-HealyNeeder-Root Phase it EVR System-VR-202-A(Scheduled Maintenance) Healy EO VR-202-A Quarterly Inspection and Testing Checklist Checklist results may be used to assist with filling out GDF maintenance log. Date: 3/19/2015 Page 1 of 3 Weekly Product Dispenser Unihose or Fuel Grade (circle one) Inspection VP1000 Dispensing Clean Air Separator Number Unihase Inspection Rate Fuel Grade Tested Complete Configuration (circle one) (gallons (circle one) g (circle one) per minute) (see figure on back) 1 Unihose 87 89 91 Other_ Yes No Pass Fail 7.89 gpm Unihose 87 89 91 Other i Valve Circle One 1 Unihose 87 89 91 Other— Yes No Pass Fail 8.13 gpm Unihose 87 19 91 Other FA en Closed 87 89 91 OtherNo Pass Fail 8.45 gpm Unihose 87 89 91 OtherOpen2 Unihose 87 89 91 OtherYes No Pass Fail 7.57 gpm Unihase 87 89 91 Other ; Open lased 2 Unihase 87 89 91 Other - Yes No Pass Fail 7.86 gpm Unihose 87 $9 91 Other D Open lased 2 Unihase 87 89 91 Other — i Yes No Pass Fail 8.21 gpm Unihose 87 89 91 Other PlugCircle One 3 Unihase 87 89 91 Other Yes No Pass Fail 8.10 gpm Unihose 87 89 91 Other- - E Installed missing i 3 Unihose 87 89 91 Other— Yes No Pass Fail 8.21 gpm Unihose 87 89 91 Other Fg Installed missin 3 Unihose 87 89 91 Other— Yes No Pass Fail 8.62 gpm Unihose 87 89 91 Other 1 4 Unihase 87 89 91 Other— Yes No Pass Fail 7.86 gpm Unihose87 89 91 Other— ly 4 Unihose 87 89 91 Other Yi — es No Pass Fail 8.07 gpm Unihose 87 89 91 Other 4 Unihose 87 89 91 Other— Yes No Pass Fail 8.31 gpm Unihose 87 8991 Other— Z 5 Unihose 87 89 91 Other — T. Yes No Pass Fail 7.17 gpm Unihose 87 89 91 Other C 5Alm Unihose 87 89 91 Other Yes No Pass Fail 7.62 m Unihose 87 89 91 Other 9p C –� J 0 5 Unihase 87 89 91 Other Yes No Pass Fail 8.13 gpm Unihose 87 89 91 Other n � — --------------- i Unihose 87 89 91 Other Yes No Pass Fail 8.33 gpm Unihose 87 89 91 Other— i WO:2321928 -- --- -- -