Pacific Site Audit Report File Contents

112827 Audit Report Form Pacific Rev A 12 22 08

Bennett Pump Company 1218 E. Pontaluna Road Spring Lake, MI. 49456
Fax: 231-799-6202

Pacific Site Audit Report
This form must be filled out and sent in to Bennett to establish the equipment warranty.

Date of Audit Date of Installation

Model and Serial Number of Dispensers and Serial Number of Secure Pump Pays (page 2 for more space): (please indicate if E-85 is used for any dispensers): ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________

Site Information: Phone: ________________________________ Name: _________________________________ Address: _______________________________ ______________________________________ City:_______________ State: _____ Zip: _____ Owned by:______________________________ Equipment Purchased Date: ________________

What type of Interface Box are you using for the Fuel Communication? ________________________ What type of Point of Sale (P.O.S.) are you using? ______________ Software Version?___________ Enter Y = Yes, N = No or N/A = not applicable:
______ Is the dispenser mechanically mounted to the island using securing bolts and metal shims? ______ Are the card reader's field wiring twisted at least 3 times per foot? ______ Is the distance between the dispenser(s) and the Interface Box less than 500 feet (150m)? ______ For the field wiring does each dispenser have a dedicated rigid metal conduit? ______ Is the field wiring Oil and Gas resistant, THHN, the right gauge and copper stranded? ______ Is the field wiring continuous with no splices? ______ Is the field wire conduits sealed for vapors in the head of the dispenser? ______ Is the resistance between Neutral and Earth Ground less than 1 ohm? Reading: Ohms. ______ Is this location using Cathodic Protection? Check the voltage between Neutral and Earth Ground. Readings: VAC VDC (see page 2 for warning) ______ Are there no more than 2 dispensers on one dedicated 15 Amp breaker? ______ Are the wires between the P.O.S. within 100 feet (30m)? ______ Is there an emergency cutoff valve mounted on each product line of the dispensers per manufacture's specifications? ______ Is all piping and cutoff valves secured per manufacture's specifications and State regulations? ______ Is the low grade coming into the left product line from side A? ______ Are there any leaks in the hydraulic assembly, hose outlets or hanging hardware? ______ Is the Pump Controller on the same phase of power as the dispensers? ______ Are all of the dispensers on the same phase of power? ______ Is an approved emergency stop relay installed and working properly for the fuel court area? ______ Are there 3 R. C. Networks installed properly in each sub-pump relay? ______ Have the meter calibrations been verified? ______ Was the Bennett Warranty statement reviewed with the station Manager / Owner and do they understand the policy? ______ Has the start-up and checklist been completed (page 16 of Installation Manual - 111102)? ______ Were all Bennett installation instructions followed per our Installation Manual (111102)? If not, please describe, in detail, anything out of the ordinary on the back (page 2).

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112827 Audit Report Form Pacific Rev A 12 22 08 Exceptions to Bennett Installation Instructions: Please list anything out of the ordinary or worth mentioned that may affect the safety or dispensing of the installed equipment. If there were any confusing instructions in our Installation Manual or start-up procedure please add your comments here. Warning: If the location is using and impressed current cathodic protection system then it is imperative that the system is hooked up correctly. An improper installation could cause damage to our equipment. Please check for stray voltage coming from this system on the Earth Ground and Neutral within the Bennett equipment.

__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Audited by: Technician: Company: Name: ___________________________________ Name: __________________________________ Email: ___________________________________ Address: ________________________________ Phone: __________________________________ Phone: _________________________________ Certification #:_____________________________ Technician Signature: Owner/Manager Signature: ________________________________________ _______________________________________ 2