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Site Number o l. "t V Date f <br /> Under Conwri nord(UDC <br /> Dbps�er txpefiear rPu. "k' t1DCk/ a s ?12�g �r <br /> y Orbs f lift '�gnd+ored UDC Type UDC dean d Ory Ftmr Connae6ots {UDC FGa F u(sirer Fu1HSetf$arra <br /> 34f era Corimtlon Condk�OrN t?h,., h,- <br /> Any drips or leaks Is =Booted Flax <br /> AD required the dispenser UDC iniad 8 in W=Water present <br /> Inside or outside SC-Sac anode(s) <br /> regulatory securely proper F=Fuel present Ara fire extinguishers <br /> 1/2 or 3,4, digG-Good of dispenser? DP=Deep NS=Not in sod <br /> F=Fair If yes explain In anchored& SH-Shallowcondrbo"n D=Debris present NP-No flex present Pasant In the llDCa Is the dispenser fulletc decals present P=Poor the comments ProPerly located NA=No UDC CD-Clean and Dry FS=Flex in soli serve or self serve? <br /> Yes or No FW=Flex in water Yes or No <br /> Yes or No Yes or No Yes or No NA=No UDC (Circle all that apply) UNK=No access <br /> W F D ) KY4 c6 <br /> L ,n1Y/� W F D <br /> W F D C. <br /> W F D CD <br /> W F D CD <br /> W F D CD <br /> W F D CO <br /> W F D CD <br /> W F D CD <br /> W F D CD <br /> Product Valvate Vapor fmpac! dr''» VAC 1/c(or Dfsprrssr UDC Sonsofe <br /> Sensor <br /> Ifrpw6Ctunr Mods#MumOsr manadact..r &"d NumtieM <br /> r Yarectwsr UDC Sensor UDC P tlfor UDC'Cundutt <br /> EBW H-Healy If sensor is metalled,is d IF no UDC Sensors <br /> EBW Emco T=Tokheirn Manufacturer& at the lowest exist, conduit <br /> or 3,4, Emco Write Model Number in space OPN Write Model Number in space W=Wayne Modal# point available to instetl? <br /> etc OPW provided _ provided NAB=Balance <br /> No <br /> UN=UnivNA=None Universal NA <br /> --None al NAD=No Stage It or NA=No Sensor Yes or NA=No Sensor <br /> Yes or No <br /> Diesel dispenser sor NA=Sensor present <br /> 2 o f ,OB -.2 C 4 <br /> 0 y 75 3 Flo -'2o Al <br /> w w o A0 <br /> Comments on any damaged/defective equipment <br /> JUL � � 2018 <br /> ENVIRONM6 NT L <br /> HEAUTH f?EP <br /> issued 12/27/2017 Page 6 of 10 <br />