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14 2018 Equipment Survey <br /> Aiif � Site Number 4-1 �' Date L �� <br /> Nozzles Breakaways Hose Retractors <br /> Dlspenser # Manufacturer Model Number Manufacturer Madel Numbor Manufacturer Condition <br /> Dispenser No . E Fuel CA = Callow CA = Callow <br /> Grade (if applicable; EW = Emco Wheaton EW = Emco Wheaton Are they installed r mounted d <br /> !or a single hale as HA = Harco EBW functioning property <br /> ( i g HE = Healy Write Model Number in space provided HE = Healy Willa Model Number In please write a m <br /> hla disprr only HK = Husky HK = Husky space provided Yes or No <br /> i regular 2 diesel, <br /> e1 l 3 OPW OPW NA s None <br /> 4 , 5 diesel, elq VST = Vapor Syst VST > Vapor Syst <br /> 5 _ C ti 71 ( � <br /> \J1 V3 <br /> ` � � �- � �_ ti's � �; ��► C ,��� 5ti�1-= C ti L � s <br /> 516 'L <br /> J <br /> Emergency Stop Switch Canopy Billboard Low Voltage Other <br /> What is the location of the e�stopo) <br /> S = Sclar Panels A Attached Is there a Bilibpard an Does the site have Low Does the site sell E•85. BG :n <br /> IN o inside Building/FCiosk 7canopies <br /> w many 820 or have an Electric Car <br /> BUILD = Outside on the Building are F Non-Solar F = Free Standing the property? Voltage Emergency Shutoff Charging Stahon7 <br /> DISP = Outside in the D=spenser Area site'+ (for Dna j GRIND <br /> TANK = Outside near the Tank Fills NA " N; Canopy NA = No Canopy Yes or No Interc43mj7 Yes or Na <br /> C r LL that apply) <br /> LINIE! UILD DISP TANK <br /> issued 12/04/2017 t V Paqe 4 of 4 <br />