File No.

: 1/1/36
Doc No.: MEEA-HSEM-C001
Rev 1 – Dec 2011

REPUBLIC OF TRINIDAD AND TOBAGO

Ministry of Energy and Energy Affairs
Service Station Inspection Checklist

This checklist is to be used as a guideline for the inspection of service stations for the renewal of marketing licenses. It
outlines the minimum requirements for inspection. Additional requirements may be considered depending on the uniqueness
of the service station.

1. Inspection Particulars
Name of Registered Licensee:

Address:

Inspection Date:

Last Inspection Date:

Inspection Officer/s:

Service Station Representative/s:

Company Representative/s:

Activity:
□Inspection □Calibration □Pre-commissioning
Station License:
□COCO □CODO □DODO
Leak Detection:
□Inventory Control □Tightness Test □Interstitial Monitoring □Other
Storage Details:

No. of Dispensing
Volume of Storage Tank Location Tank Wall Type
Nozzles

Diesel
1. □AG □UG □Single □Double
2. □AG □UG □Single □Double
Super 1. □AG □UG □Single □Double
Gasolene 2. □AG □UG □Single □Double
Premium 1. □AG □UG □Single □Double
Gasolene
2. □AG □UG □Single □Double
Regular
Gasolene □AG □UG □Single □Double
Kerosene □AG □UG □Single □Double
LPG .................... X 20lbs NA NA NA

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 2. Inspection Checklist
Tick as appropriate. A tick in the shaded region must be accompanied by a comment.
Legend: Y – Yes N – No NA – Not Applicable

Y N NA Comments
A. Documents and Records
1. Is the marketing license up to date?
☐ ☐ ☐ Expiry Date:………………………
2. Is the marketing license displayed for public view? ☐ ☐ ☐
3. Is the latest revision of the signed and dated HSE Policy statement
displayed? ☐ ☐ ☐
4. Are emergency contact numbers posted?
Should include: Fire, Ambulance, Police, Manager, Dealer, etc.
☐ ☐ ☐
5. Is an adequate ERP readily available?
Should contain as a minimum:
(1) Procedures to be followed in case of fire, such as sounding the alarm, notifying
the Fire Service, evacuating personnel, and controlling and extinguishing the fire.
(2) Procedures and schedules for conducting drills.
(3) Appointment and training of personnel to carry out assigned duties, including
review at the time of initial assignment, as responsibilities or response actions ☐ ☐ ☐
change, and whenever anticipated duties change.
(4) Maintenance of fire protection equipment.
(5) Procedures for shutting down or isolating equipment to reduce the release of
liquid, including assigning personnel responsible for maintaining critical plant
functions or shutdown of plant processes.
(6) Alternate measures for the safety of occupants.
6. Are SOPs available and adequate?
Should include fuelling, RTW offloading, product transfer, dispensing, etc. ☐ ☐ ☐
7. Is a plot plan showing location of fire extinguishers, escape paths, muster
point, ESD switches, etc. displayed? ☐ ☐ ☐
8. Is a colour code chart available?
Gray – Diesel; Blue – Kerosene; Red – Super; White – Premium; Black – Regular.
☐ ☐ ☐
9. Are MSDS available for the hazardous products stored/ dispensed? ☐ ☐ ☐
10. Are employees involved in fuel transfer trained in proper procedures to
handle fires, overfill, or fuel spillages, types of improper and illegal
containers and fire extinguishers use?
☐ ☐ ☐
Verify by interviewing employees.
11. Are emergency drills conducted and recorded?
Verify by interviewing employees. ☐ ☐ ☐
12. For single walled tanks, are inventory records satisfactory?
Check: availability, completed daily, all fields completed, etc. ☐ ☐ ☐
13. For single walled tanks, do inventory records suggest no leaks?
Check: % variance < 1% on consecutive days.
☐ ☐ ☐
14. For interstitial space monitoring tanks, are leak detection records (print
outs) performed at least every 7 days? ☐ ☐ ☐
15. For interstitial space monitoring tanks, do records suggest that the tanks
are free of leaks? ☐ ☐ ☐
16. Is the compressor’s relief valve annual certification up to date? ☐ ☐ ☐
17. Are underground storage tanks checked for water on a daily basis? ☐ ☐ ☐
18. Are conspicuous signs of the following displayed for customer view:
a) Fuel will not be dispensed into unapproved containers (or
equivalent)? ☐ ☐ ☐
b) Fuel in excess of 100 litres will not be dispensed into portable
containers (or equivalent)? ☐ ☐ ☐
19. Are records of fuel sales greater than 100 litres to customers maintained
at the service station? ☐ ☐ ☐

B. Store Room □ NA □ No longer in use

1. Is the room free of fuel storage? ☐ ☐ ☐
2. Is a pathway of 1m width maintained for access? ☐ ☐ ☐
3. Are materials safely stacked?
Check material compatibility, height of stacks, etc.
☐ ☐ ☐
4. Are top shelves provided with fall barriers at the front? ☐ ☐ ☐
5. Is adequate lighting provided? ☐ ☐ ☐

C. Compressor Room □ NA □ No longer in use

1. Is the room safely located?
Consider fuel storages, noise, etc. Check aboveground and readily accessible.
☐ ☐ ☐

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 Y N NA Comments
2. Are adequate guards provided over moving parts?
If wire mesh is installed it should not permit hand entry.
☐ ☐ ☐
3. Is a relief valve installed and in good condition?
Check set pressure if PRV is 110% tank pressure.
☐ ☐ ☐
4. Is the compressor certification expiry date stencilled on? ☐ ☐ ☐ Expiry Date:………………………
5. Is there no valve between the compressor tank and relief valve? ☐ ☐ ☐
6. Is the room free of combustibles and other material? ☐ ☐ ☐
7. Is the compressor in good condition?
Check for corrosion, damage, etc.
☐ ☐ ☐
8. Is piping in good condition? ☐ ☐ ☐
9. Is a pressure gauge provided at the compressor (tank) discharge?
Check condition of pressure gauge, readily readable and operating range. ☐ ☐ ☐
10. Is a drain pipe and valve provided at the lowest point on the compressor
tank? ☐ ☐ ☐

D. Fire Prevention
1. Are adequate number and type of fire extinguishers provided?
Check minimum one per plinth (type 20-BC) ☐ ☐ ☐
2. Are fire extinguishers in good condition?
Check: fully charged, condition of hoses, inspected monthly, corrosion, etc.
☐ ☐ ☐
3. Are last annual test dates acceptable? ☐ ☐ ☐ Last Test Date:………………………..
4. Are fire extinguishers readily available?
Should be < 100 ft. from dispensers. ☐ ☐ ☐
5. Is a fire proof bin provided? ☐ ☐ ☐
6. Is dry sand provided in red labelled (‘FIRE’) bins? ☐ ☐ ☐
7. Are sand bins in good condition?
Check: bins free of garbage, sand tilled, cover in place, etc. ☐ ☐ ☐
8. Are “NO SMOKING”. NO NAKED LIGHTS and “WHEN FILLING SWITCH
OFF ENGINE” signs displayed? ☐ ☐ ☐
Check: No Smoking letters must be ≥6” and all letters must be red.
9. Are signs in good condition?
Check: conspicuous letters, in view of all vehicles fuelling, etc. ☐ ☐ ☐

E. LPG Storage □ NA □ No longer in use

1. Is storage safely located?
Check: >10’ from ignition sources, vehicular impact protection, etc. ☐ ☐ ☐
2. Are set back distances observed?
Quantity Building/ Property that Sidewalk/ Church, School,
can be built upon
≤ 720 lb 0 ft. 0 ft.
☐ ☐ ☐
721 – 2,500 lb 0 ft. 10 ft.
2,501 – 6,000 lb 10 ft. 10 ft.
3. Is the enclosure at least 20ft. from fuel dispensers? ☐ ☐ ☐
4. Is the enclosure at least 5 ft. from doorways of buildings with two means of
egress and 10 ft from buildings with one means of egress? ☐ ☐ ☐
(Only if the building is open to the public).
5. Is the area free of weeds, vegetation and combustibles? ☐ ☐ ☐
6. Is a lockable ventilated enclosure of metal exterior construction provided? ☐ ☐ ☐
7. Are cylinders stacked upright and no more than 3 per column? ☐ ☐ ☐
8. Are cylinders stored on a level and non-flammable base that will not
collect water? ☐ ☐ ☐
9. Are warning signs posted?
(No Smoking, No Parking Within 3m, LPG, Flammable)
☐ ☐ ☐

F. Aboveground Storages □ NA □ No longer in use

1. Is minimum safety separation distances of the tanks from property lines,
public ways and important buildings observed?
Tank Capacity Property Line that From building or
can be built upon (ft.) Public way (ft.) (Gals)
275 or less 5 5 ☐ ☐ ☐
276 to 750 10 5
751 to 12,000 15 5

2. Are tanks safely located?

Consider slope stability, fire fighting access, ignition sources, vehicular damage, etc. ☐ ☐ ☐
3. Are tanks foundation and supports adequate and in good condition?
Consider corrosion, uneven settling, etc.
☐ ☐ ☐

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 Y N NA Comments
4. Are steel support structures protected by materials having a fire resistance
rating of at least 2 hours? ☐ ☐ ☐
5. Are vent outlets at least 5 ft. (1.5 m) from building openings and at least
15 ft. (4.5 m) from powered ventilation air intake devices? ☐ ☐ ☐
6. Are vent pipes outlets protected to minimize the possibility of blockage
from weather, dirt, or insect nests? ☐ ☐ ☐
7. Are all openings other than vents provided with vapour tight covers? ☐ ☐ ☐
8. Is piping to and from the tanks provided with valves located as close as
practical to the shells? ☐ ☐ ☐
9. Are bleed piping provided with a liquid tight closure such as a valve, plug,
or blind, or a combination of these? ☐ ☐ ☐
10. Is transfer pump classified for its location? ☐ ☐ ☐
11. Is transfer pump in good condition?
Check for leaks, connections, etc.
☐ ☐ ☐
12. Are means provided for determining tank levels?
Sight gauges should be protected heat resistant glass and a valve installed at the ☐ ☐ ☐
base.
13. Are stairways/ladders adequate and in good condition?
Check corrosion, damage, antiskid material, safe access, etc. ☐ ☐ ☐
14. Is gauging platform adequate and in good condition?
Check damage, level, handrails, etc.
☐ ☐ ☐
15. Is rigid metal fill/ withdrawal/ bleed piping provided? ☐ ☐ ☐
16. Is piping in good condition?
Check supports, leaks, corrosion, etc. ☐ ☐ ☐
17. Are tanks adequately electrically earthed? ☐ ☐ ☐
18. Are tanks provided with adequate secondary containment?
Check 110% the largest tank.
☐ ☐ ☐
19. Is the bund in good condition?
Free of cracks, openings, combustibles, garbage, hydrocarbons, water, impervious, ☐ ☐ ☐
drums, etc.
20. Is an adequate bund valve and sign, “KEEP VALVE CLOSED WHEN
UNATTENDED”, provided? ☐ ☐ ☐
21. Is the bund valve kept closed? ☐ ☐ ☐
22. Do liquids drain towards the bund valve? ☐ ☐ ☐
23. Are means provided to prevent vehicular damage of the tanks? ☐ ☐ ☐
24. Are means provided to prevent tampering? ☐ ☐ ☐
25. Are tanks colour coded (Diesel-Gray; Kerosene – Blue)? ☐ ☐ ☐
26. Are tanks suitably labelled to show identity, capacity and No Smoking? ☐ ☐ ☐
27. Are tanks in good condition?
Check corrosion, leaks, indentations, etc.
☐ ☐ ☐

G. Underground Storages Tanks (USTs)

1. Are filling/pump hatches covers and a 4-6” perimeter border appropriately
colour coded? ☐ ☐ ☐
2. Are filling/pump hatches covers secured to prevent tampering? ☐ ☐ ☐
3. Are filling/pump hatches piping provided with caps and appropriate seals
on the inside of the same? ☐ ☐ ☐
4. Is an easy means of opening the filling/pump hatches covers provided? ☐ ☐ ☐
5. Are filling/pump hatches covers water tight or raised above the level of the
surrounding ground to prevent the entry of surface water and of sufficient
strength to withstand the maximum loads of vehicles anticipated at the ☐ ☐ ☐
station
6. Are filling/pump hatches sumps free of fuel and water? ☐ ☐ ☐
7. Are fill piping tagged with the product name in the UST? ☐ ☐ ☐
8. Are leak detection sensors in the pump hatches sumps in their proper
positions to facilitate effective operation? ☐ ☐ ☐
9. Are overfill protection devices functional and in good condition?
Function test the alarm
☐ ☐ ☐
10. Are all switches on the overfill protection devices labelled? ☐ ☐ ☐
11. Are all tanks free of water?
Verify by checking. ☐ ☐ ☐
12. Are there secondary means to determine USTs volumes that have
automatic gauging as the primary monitoring method? ☐ ☐ ☐
Check for calibration charts and gauging rods?
13. Are gauging rods for each tank distinguishable?
Check: Rods should bear the tank# and colour coded?
☐ ☐ ☐

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 Y N NA Comments
14. Are gauging rods satisfactory?
Check: free of bends, accuracy at least 1/8”, ideal length for tank, etc.
☐ ☐ ☐

H. Underground Storage Tanks Vent Piping

1. Are vent pipes identified and/or colour coded? ☐ ☐ ☐
2. Do vent pipes discharge in an upward direction? ☐ ☐ ☐
3. Are vent pipes located so that the discharge point is outside of buildings,
higher than the fill pipe opening, and not less than 12 ft. (3.6 m) above the ☐ ☐ ☐
adjacent ground level?
4. Are vent outlets at least 5 ft. (1.5 m) from building openings and at least 15
ft. (4.5 m) from powered ventilation air intake devices ☐ ☐ ☐
5. Are vent pipe outlets located and directed so that vapours will not
accumulate or travel to an unsafe location, enter building openings, or be ☐ ☐ ☐
trapped under eaves?
6. Are vent pipes located so that they will not be subjected to physical
damage? ☐ ☐ ☐
7. Are separate vents provided for each tank? ☐ ☐ ☐
8. Are vent pipes installed without sags or traps in which liquid can collect? ☐ ☐ ☐
9. Are vent pipes outlets protected to minimize the possibility of blockage
from weather, dirt, or insect nests? ☐ ☐ ☐
10. Are vent pipes properly secured/ supported? ☐ ☐ ☐
11. Are vent pipes in good condition?
Check for corrosion and structural damage.
☐ ☐ ☐

I. Dispensing Units
1. Are all dispenser sumps clean and empty?
Check: No water, product, or debris. ☐ ☐ ☐
2. Are all sumps free of cracks, bulges and holes? ☐ ☐ ☐
3. Are leak detection sensors in the correct position and height? ☐ ☐ ☐
4. Are pumps free of leaks? ☐ ☐ ☐
5. Is piping (inside dispenser unit) in good condition?
Check: No corrosion, swelling, indentations, etc.
☐ ☐ ☐
6. Flex connectors are not in contact with other components, soil (without
corrosion protection) or debris? ☐ ☐ ☐
7. Are areas around the dispensers free of excess spillages? ☐ ☐ ☐
8. Are face glasses in place? ☐ ☐ ☐
9. Do all pumps display the product to be dispensed? ☐ ☐ ☐
10. Are all pumps provided with ID lamps? ☐ ☐ ☐
11. Are pumps on the same plinth distinguishable by numbering or lettering? ☐ ☐ ☐
12. Are all pumps panels satisfactorily in place and secured? ☐ ☐ ☐
13. Are dispensing units located such that all parts of vehicle being fuelled are
on the station premises? ☐ ☐ ☐
14. Are dispensing units on a concrete island (plinth) above the grade level
and bolted in place? ☐ ☐ ☐
Should be at least 150mm high.
15. Are dispensing devices protected by substantial collision protection at the
ends of the islands? ☐ ☐ ☐
16. Are dispensers provided with controls that permit the pump to operate only
when a dispensing nozzle is removed from its bracket or normal position?
This control should also stop the pump when nozzles are returned to their ☐ ☐ ☐
storage position.
17. Are dispensing units in good condition?
Check corrosion, damage, tampering, etc.
☐ ☐ ☐
18. Are emergency shutdown switches or circuit breaker for the dispenser
sales pump provided at a remote location? ☐ ☐ ☐
19. Are switches labelled to show pump numbers?
If there is one switch, it should state “Emergency Shut Down”. ☐ ☐ ☐
20. Are emergency shutdown switches readily accessible? ☐ ☐ ☐
21. Are emergency shutdown switches in good condition?
Consider exposed wiring, broken parts, etc. ☐ ☐ ☐
22. Are dispensing hoses no greater than 18 ft. in length and approved for the
intended service? ☐ ☐ ☐
23. Are dispensing hoses equipped with emergency breakaway devices? ☐ ☐ ☐

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 Y N NA Comments
24. Are hoses in good condition?
Check for kinks, flattened areas, leaks, insulation damage, etc.
☐ ☐ ☐
25. Are automatic closing type nozzles provided? ☐ ☐ ☐
26. Are nozzle faces appropriately colour coded and in good condition? ☐ ☐ ☐

J. Attended Self Service Stations □ NA

1. Is at least one attendant on duty while the station is open to the public? ☐ ☐ ☐
2. Are clear operating instructions displayed at every dispenser? ☐ ☐ ☐
3. Is the dispensing area in clear view from the console area/cashier (area
having control of the emergency shut-off devices for all and individual ☐ ☐ ☐
dispensing units)?
4. Is a means of communication (e.g. intercom) between the console/ cashier
operator and persons at the dispensing area provided? ☐ ☐ ☐
Verify functionality of system by testing.

K. Electrical
1. Are all lights clean, functional and adequate?
Function test lights. ☐ ☐ ☐
2. Are lights over the dispenser area provided with means of fall prevention? ☐ ☐ ☐
3. Is all electrical equipment suitable for their area classification (Ref. NFPA
70)? ☐ ☐ ☐
Check: explosive-proof conduits with no exposed wiring or open boxes
4. Are all water coolers, ice machines, refrigerators and similar electrical
equipment properly grounded? ☐ ☐ ☐
5. Are electrical panels and junction boxes provided with covers to protect
against accidental contact with energized conductors? ☐ ☐ ☐
6. Are there no exposed wires in the electrical panel boxes? ☐ ☐ ☐
7. Are all breakers in the electrical panel boxes labelled to show their
function? ☐ ☐ ☐

L. Service Bay □ NA □ No longer in use

1. Is location suitable? ☐ ☐ ☐
2. Are all effluents routed to oil/water separators? ☐ ☐ ☐
3. Are oil/water separators functioning properly?
Check effluent discharge. ☐ ☐ ☐
4. Are separators covered? ☐ ☐ ☐
5. Are sediment traps provided? ☐ ☐ ☐
6. Is sludge from separators suitably disposed? ☐ ☐ ☐
7. Is waste oil collected and disposed suitably? ☐ ☐ ☐
8. Are the lifts in good operating condition? ☐ ☐ ☐
9. Are lift clamps in good operating condition? ☐ ☐ ☐
10. Is housekeeping satisfactory? ☐ ☐ ☐
11. Is effluent sampled and tested to verify compliance with the Water
Pollution Rules? ☐ ☐ ☐

M. General
1. Are there no ‘unapproved’ storages? ☐ ☐ ☐
2. Are there no ‘unapproved’ storage conversions? ☐ ☐ ☐
3. Does the station allow a free flow of traffic? ☐ ☐ ☐
4. Is the condition of the surroundings satisfactory?
Check: Vegetation overgrowth, excess spillages, tilted electrical poles, electrical ☐ ☐ ☐
hazards, slope failures, etc.
5. Is adequate surface drainage provided?
Check for damaged/missing drain covers, clogging, etc.
☐ ☐ ☐
6. Is paving of the compound satisfactory? ☐ ☐ ☐
7. Are toilet facilities provided? ☐ ☐ ☐
8. Are toilet facilities in good working order? ☐ ☐ ☐
9. Is running water available? ☐ ☐ ☐
10. Are adequate first aid supplies available?
Check for expired and depleted items.
☐ ☐ ☐

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 Y N NA Comments
11. Is an oil spill kit available? ☐ ☐ ☐
12. Is the canopy in a good condition?
Check: structural members for damage, hazards, leaking roof, missing guttering, ☐ ☐ ☐
loose material, corrosion, wasps, etc.
13. Is the building structure in good condition? ☐ ☐ ☐
14. Is the general aesthetics of the station satisfactory?
Check: paint job, company sign, etc.
☐ ☐ ☐
15. Are there no observations of operational infractions?
Check:
o fuel dispensing into unapproved containers,
o fuel dispensing into vehicles with engine running,
o deliberate spillage of fuel from dispensers,
o vehicles being fuelled outside the station premises, ☐ ☐ ☐
o vehicles using the station as a thoroughfare to avoid external traffic
congestion, smoking,
o dispensers in service when RTW is filling tanks, etc.
o fuel volume in excess of 100 litres being dispensed.
16. Are employees properly attired? ☐ ☐ ☐
17. Is the station free of obsolete equipment? ☐ ☐ ☐

3. Pre-commissioning Inspection Addendum

Y N NA Comments
A. Documents and Records
1. Is the EMA’s CEC provided?
☐ ☐ ☐
2. Is TCPD’s approval provided? ☐ ☐ ☐
3. Is Electrical Inspectorate certification provided? ☐ ☐ ☐
4. Is OSHA’s pressure test certificate provided? ☐ ☐ ☐
5. Is Fire Service Division approval provided? ☐ ☐ ☐
6. Is a Contamination Assessment Report provided? ☐ ☐ ☐
7. Is a Remediation Report provided? ☐ ☐ ☐
8. Is City/Borough/Regional Corporation approval provided? ☐ ☐ ☐
9. Is a Decommissioning Report provided. ☐ ☐ ☐
10. Are updated ‘as built’ drawings provided? ☐ ☐ ☐
11. Are all documents for issuance of the Marketing Licence provided?
Check with Downstream and Retail Marketing Division. ☐ ☐ ☐

B. Sensors verification
1. Are all level sensors in good condition?
Check for kinks, etc.
☐ ☐ ☐
2. Are all water detection sensors and alarms functional? ☐ ☐ ☐
3. Are all overfill protection sensors and alarms functional? ☐ ☐ ☐
4. Are all interstitial space sensors and alarms in good condition? ☐ ☐ ☐
5. Are all interstitial space sensors functional? ☐ ☐ ☐
6. Are all dispenser sump sensors and alarms functional? ☐ ☐ ☐
7. Are all dispenser sump sensors properly positioned? ☐ ☐ ☐

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 4. Service Station’s Assessment
Rating
Very Poor Poor Fair Good Very Good
Service Station Assessment Parameters
(1) (2) (3) (4) (5)
1. Documents and Records ☐ ☐ ☐ ☐ ☐
2. Signs and Notices ☐ ☐ ☐ ☐ ☐
3. General Aesthetics ☐ ☐ ☐ ☐ ☐
4. Housekeeping and Cleanliness ☐ ☐ ☐ ☐ ☐
5. Equipment Condition, Maintenance and Operation ☐ ☐ ☐ ☐ ☐
6. Buildings and Structures Condition ☐ ☐ ☐ ☐ ☐
7. Current Operations and Service ☐ ☐ ☐ ☐ ☐

Service Station Overall Assessment ☐ ☐ ☐ ☐ ☐

5. Remarks

…End of Checklist…

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 6. Pump Calibration Report

Name of Service Station

Calibration Date

Product Abbreviation Price per 20 Litre DSP

Yes No NA
litre Reading
Diesel
Super Gasolene
D
S
$1.50
$2.70
$30.00
$54.00
Is can certification current?
□ □ □
Premium Gasolene
Regular Gasolene
P
R
$4.00
$2.60
$80.00
$52.00
Is can in good condition?
Check: Free of dents, etc.
□ □ □
Kerosene K $1.50 $30.00

Error
Side/ Error (ml)
DSP # Product Corrected Comments
No.
High Low Nil Yes No
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐

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Web: [email protected].
 Error
Side/ Error (ml)
DSP # Product Corrected Comments
No.
High Low Nil Yes No
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
☐D ☐S ☐P ☐R ☐K ☐ ☐ ☐
Total

Remarks

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…End of Document…

The reproduction of this document is prohibited without permission of the MEEA. Page | 10
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Web: [email protected].