Gasboy SiteOmat Maintenance Manual - Manual (Page 276)

272 SiteOmat Setup and Maintenance Manual – MDE 4817G
APPENDIX C
SITE SURVEY FORM – FUEL TRUCK STATION
Date: / /
Prepared by:
e-mail:
Phone: @
Gas Station Identification
:
Company name
Address
Contact person:
Phone: Mobile phone:
Truck Data
:
Station name:
Site Name:
Power Supply: 12VDC 24VDC Other
Number of nozzles
(To be connected to Fuel Truck Controller):
Number of Authorizers required:
Hose on: Reel Long hose Other (photo required)
Reel has continued connectivity (brushes) Yes No
Electronic Pulser installed: Yes No
If Pulser installed, model?
Air Slip needed: Yes No
On/Off switch available: Yes No