Gasboy Fuel Truck Controller - Manual (Page 87)

Fuel Truck Controller Manual 81
APPENDIX B
SITE SURVEY FORM - EXAMPLE
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
Mini Fuel Truck Controller Printer required:  Yes  No
Preferred mounting location
for Fuel Truck Controller box: _________________________