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by 2018 Equipment <br /> 0 Site Number S � Date -7 <br /> D[d. . t9r kkditbay M' AAddel . <br /> ,e <br /> Dispenser No.&Fuel CA=Catiovr CA=Catlow <br /> Grade(if applicable) EW=Emoo Wheaton EW-Emco Wheaton Are they installed/mounted& <br /> (for a single hose gas HA=Harco EBW Numb Write Modal Number in functioning propwiy <br /> IM dip#only HE=Healy Write Model Number In space provided HE=Healy space pPlease write h in <br /> 1 regular,2 midgrade,3. HK=Husky HK=Husky Yes or No <br /> 4,5 diesel,etc) OPW OPW NA=None <br /> VST=Vapor Syst. VST-Vapor Syst. <br /> 2-" t.4005 i" - '\)Sl Ev4=5� C-N' s <br /> $y CN7 eS <br /> 6 �w �4�05 Sfi imy- - SK1- CN z e <br /> 4vv-- s 9 tic <br /> Ll <br /> \i h <br /> NVI <br /> nrG PAPTNAr NT <br /> What Is the location of the a-stop? <br /> S=Solar Panels A=Attached Is there a Billboard on Does the site have Low Does the site set E-65,B6 to <br /> IN=Inside BufldingACosk How many F=Non Soles F=Free Standing the property t Nonage Emergenc�y Stwt oft 820 or have an Electric Car <br /> BUILD=Outside on the Building canopies are (for Data/ ncy S/ Charging Station? <br /> DISP=Outside In the Dispenser Area onsite? NA=No Can <br /> TANK=Outside near the Tank Fills opt' NA=No Canopy Yes or No Intarcomn <br /> Yes or No <br /> (Cireh Al.Lthat apply) <br /> IN ELD DISP TANK ' fl <br /> issued 12/0412017 Page 4 of 4 <br />