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Site Number pate <br /> Nozzles Breakaways Nozzles Breekaways <br /> Dispenser# I Manufacturer Model Number Manufacturer I Model Number Dispenser# Manufacturer Model Number Manufacturer I Model Number <br /> Dispenser No.8 Fuel CA-Ca Dispenser No.d Fuel CA=Cadow <br /> Grade if applicable) EW=Emoo Wheaton CA=Callow EW=Emco Wheaton CA=Cetltriv <br /> ( PP ) HA=Harco EW=Emco Wt Grade(if applicable) HA=Harco EW=Emco w <br /> (for a single hose gas Write Model Number Write Model Numbe (for a single hose gas Write Model Nu be Wt Write Model Number <br /> list disp.#only HK=Husky In space provided HE=Healy in space provMed list dis.#only HK=Husky HE-Healy <br /> HL=Healy HU=Husky P Y HL= in space provided ins ace mvided <br /> 1 regular,2 midgrada OPW OPW t regular,2 midgrade Healy HU=Husky p p <br /> 3,4,5 diesel,etc) VST Vapor S st 3,4,5 diesel,etc) OPW OPW <br /> P Y VST=Vapor Syst <br /> vc.;,T-- v-r E-v>e I v sr- I eq-s <br /> 2- <br /> 57 S <br /> ENN ONME LTH <br /> D <br /> 1 <br /> - '/� <br /> IF <br /> Tank Field <br /> Observation Price!ID Slgn Canopy easement Billboard Other <br /> Walla <br /> Quantity of Does the site has an Is the canopy. Is there a basement, ones the Bila seer E- <br /> Observation Well ID sign over 30 feet S=Arched Solar Panel Attached or Free crawl spew.or Is there a Billboard on the property? e5,e6 to 820 or <br /> high F=Flat Non-Solar Deck Standing? underground bays? have an Electric CarCharging Station? <br /> Write in number NA=No Canopy Yat or No <br /> UNK=Unknown Yes or No Yes or No Yes or No Yes or No <br /> 14 1 <br /> --- <br /> Emergency Stop Switch <br /> What Is the rotation of the a-stop? <br /> IN-Inside BuOding/Kiosk <br /> BUILD-Outside on the Building <br /> DISP-Outside in the Fueling(dispenser)Area <br /> TANK-Outside near eu Tank Fill <br /> (Circle ALL that a n) <br /> IN DISP TANK <br /> meuveo}narlais Page 4 of 4 <br />