Registration #: 201500024Name: KUM & GO #521
Address: 205 2ND STCity: Coralville  Zip: 52241  Field Office: 6
Dispensers and Secondary Containment (UDC)

Dispenser Area
Manufacturer
Model
Install Date
High Blend Ethanol, ULSD, and BioDiesel Compatible
Check if connected to Satellite Disp.
UDC
Check if UDC Present
Manufacturer
UDC Material
Check if Double Wall
UDC Monitoring
Monitoring
Sensor Make
Sensor Type
Control Panel Make/Model
Check if satellite disp. has same UDC and monitoring equipment as primary (if not, explain in Notes)
Notes
Remove Dispenser
  • Dispenser 1/2
  • Dispenser 3/4
  • Dispenser 5/6
  • Dispenser 7/8
  • Dispenser 9/10
  • Dispenser 11/12
  • Dispenser 13/14
  • Dispenser 15/16


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