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Dispenser Continuity Test Form

EXAMPLE

Facility Name:
Cost Center:
Address: Page of
Instruments Used for Testing:
Continuity Test Date Test Performed

Customer: Earth/Ground Test: Technician:

Mode of Failure
Hanging Hardware Continuity Test
Fueling Record of Comments
Hose No. Product Initial Test Retest
Position (Please indicate manufacturer of failed equipment when known)
Reading Reading
F-SJ F-BW F-LH F-SH F-VG F-NS
(megohms) Pass Fail (megohms) Pass Fail

1 Regular 0,8 Pass

1 Plus 1,25 F 0,9 Pass X Replaced Husky Part No. 3360VR breakawy

1 V-Power 1,5 F 0,85 Pass X Disassembled hose to swivel joint conmnection, lubricated threads and reassembled

1 Diesel 0,8 Pass

Regular

Plus

V-Power

Diesel

Regular

Plus

V-Power

Diesel

Regular

Plus

V-Power

Diesel

Page 1 of 5
Dispenser Continuity Test Form

Facility Name:
Cost Center:
Address: Page of
Instruments Used for Testing:
Continuity Test Date Test Performed

Customer: Earth/Ground Test: Technician:

Mode of Failure
Hanging Hardware Continuity Test
Fueling
Hose No. Product Initial Test Retest
Position
Reading Reading
(megohms) Pass Fail (megohms) Pass Fail F-SJ F-SW F-LH F-SH F-VG F-NS

Regular

Plus

V-Power

Diesel

Regular

Plus

V-Power

Diesel

Regular

Plus

V-Power

Diesel

Regular

Plus

V-Power

Diesel

Page 2 of 5
Dispenser Continuity Test Form

Facility Name:
Cost Center:
Address: Page of
Instruments Used for Testing:
Continuity Test Date Test Performed

Customer: Earth/Ground Test: Technician:

Mode of Failure
Hanging Hardware Continuity Test
Fueling
Hose No. Product Initial Test Retest
Position
Reading Reading
(megohms) Pass Fail (megohms) Pass Fail F-SJ F-SW F-LH F-SH F-VG F-NS

Regular

Plus

V-Power 1

Diesel

Regular

Plus

V-Power

Diesel

Regular

Plus

V-Power

Diesel

Regular

Plus

V-Power

Diesel

Page 3 of 5
Dispenser Continuity Test Form

Facility Name:
Cost Center:
Address: Page of
Instruments Used for Testing:
Continuity Test Date Test Performed

Customer: Earth/Ground Test: Technician:

Mode of Failure
Hanging Hardware Continuity Test
Fueling
Hose No. Product Initial Test Retest
Position
Reading Reading
(megohms) Pass Fail (megohms) Pass Fail F-SJ F-SW F-LH F-SH F-VG F-NS

Regular

Plus

V-Power

Diesel

Regular

Plus

V-Power

Diesel

Regular

Plus

V-Power

Diesel

Regular

Plus

V-Power

Diesel

Page 4 of 5
Dispenser Continuity Test Form

Facility Name:
Cost Center:
Address: Page of
Instruments Used for Testing:
Continuity Test Date Test Performed

Customer: Technician:

Hanging Hardware Continuity Test Mode of Failure


Fueling Initial Test Retest Record of Comments
Hose No. Product
Position Reading Reading (Please indicate manufacturer of failed equipment when known)
F-SJ F-BW F-LH F-SH F-VG F-NS
(megohms) Pass Fail (megohms) Pass Fail

Regular

Plus

V-Power

Diesel

Regular

Plus

V-Power

Diesel

Regular

Plus

V-Power

Diesel

Regular

Plus

V-Power

Diesel

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