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2018 Equipment Survey <br /> Site Number Date <br /> Date <br /> Nozzles Breakaways Hose Retractors <br /> Dispernerll Manufacturer Model Number Manufacturer Model Number Manufacturer Condition <br /> Dispenser No 8 Fuel CA = Callow CA = Callow <br /> Grade Id apo & F et EW = EI® eo Vvheatsr EW = Emco Wheaton Are they installed t mounlyd 8 <br /> Gra angle hose gas HA = Harro EBW Wnte Model Number in functioning pruperq <br /> (folist single <br /> on HE o Healy Wrto MidM Number in spare puiv drd HE = Healy spare Fr v:ded Please wroo it in <br /> I regular 2 disp# on yde 3 HK = Husky HK = Husky Yes or No <br /> air : OPW NA = None <br /> 4 5 diesel eF <br /> VST = Vapor Syst VST = Vapor Syst <br /> eL �S �S 5 �s <br /> I <br /> E <br /> I <br /> s <br /> E <br /> Ertter <br /> _go= Stop switch Canopy Billboard LowVoha a Other <br /> What is the location of the a- slap? <br /> S = Solar Panels A = Attached Is there a B.IIOoaed C:n Dees the site have Lbw Does inc site sell 685 8510 <br /> IN inside Bu 'dingtKwsk How manyB20 or have an Eleclf. Car <br /> Bell; O = 7uts+oe on the Building canopies are F = Non-Solar F m Free Standing the property.� Vo tsge Emergency Shut-off charging Stalcn + <br /> DISP = Outside in the Dispenser Area onsde% (for Data t CRsND t <br /> TANK = Outside near the Tank Fills NA = No Canopy NA = No Canopy Yes or No Iniercomt7 Yes yr No <br /> (GI le ALL that apply) <br /> IN BUILD DISP TANK �--' Y, 17 S <br /> issued 12/04/2017 Page 4 of 4 <br /> I <br />