Site Survey Form. 0.00% Surveyor: 0 Current Brand:

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Clementine Hopkins
6 years ago
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1 Site Survey Form Site Information HOST # Franchise Name: Ordered By: Address: Store Phone: City: Fax Number: State: Store Manager: Zip: Sales Tax Rate:.% Surveyor: Current Brand: Circle the correct Pacific Pride site type: Pacific Pride PrideNet AmeriNet Site Layout Franchise Name as it will appear on signage? (Must be approved by Pacific Pride) Name: Address City, St. 24hr/Emergency Phone #: In the space below draw a site plan of the property including all canopies, buildings, dispenser islands, area lights, carwash and price signs with measurements. Include compass layout along with primary and secondary streets. Specify the fueling position numbers when drawing the dispenser islands. PP Survey, Pacific Pride Material Survey Form updated xlsm, 8/1/211, 1 of 7

2 Dispenser / Information Bezel #'s are sold as kits, (as listed below). (Two Bezel # kits will be required for sgl/dual dispensers) Column Flag Signs are recommended for MPD's only, Flag Signs identifying sgl/dual dispensers could confuse the customer. Please identify the quantity of each Bezel # kit along with the quantity of each Flag Sign # kit listed below. Bezel #1-6 Bezel #7-12 Qty Bezel #13-18 Bezel #19-24 Flag Sign Blanks Flag # 1-6 Flag # 7-12 Flag # Flag # NOTE: Different pump types are decided by Manufacturer and Model #. If you have a two pumps of the same Make and Model but they dispense different grades of fuel then you would consider them to be Type 1 pump and Type 2 pump. If they dispensed the exact same fuels, they would be considedered 2 ea. of Type 1 pump. Type 1, Qty-Type 2 Qty-Type 3 Type 2 Type 3 Qty-Type 4 Type 4 Qty-Type 5 Fueling areas without Canopy Type 5 Number of Islands? Qty of straight bollards? Quantity of "U" bollards Quantity of raised bollards? Qty of island Light Poles? Trash Cans/Washer Units Qty of new Trash Containers requested? Qty of new Washer Units requested? Qty of 9.25"x8.75" Wash Bucket inserts requested? Qty of 11.8"x11" Wash Bucket inserts requested? PP Survey, Pacific Pride Material Survey Form updated xlsm, 8/1/211, 2 of 7

3 Automotive Canopy Canopy Length Canopy Width Fascia Height. Quantity of existing fascia layers on canopy? How many existing logo signs on fascia? Qty of existing Square Canopy Corners? Qty of existing Radius Canopy Corners? Number of Islands? Qty of straight bollards? Quantity of raised bollards? Number of columns? Quantity of "U" bollards Quantity of new "Pacific Pride" logos requested? Is existing fascia smooth with no reveals? Will new bottom trim 1"x4" be required? Will new fascia back supports be required? If any, what is the requested 11" custom fascia lettering for the canopy? tes/misc. Canopy Information: Draw detail of fascia to include gutter dimensions (& previous fascia height, if existing) If canopy deck or gutter is damaged, include exact dimensions for replacement parts along with quantities. PP Survey, Pacific Pride Material Survey Form updated xlsm, 8/1/211, 3 of 7

4 Diesel Canopy Canopy Length Canopy Width Fascia Height. Quantity of existing fascia layers on canopy? How many existing logo signs on fascia? Qty of existing Square Canopy Corners? Qty of existing Radius Canopy Corners? Number of Islands? Qty of straight bollards? Quantity of "U" bollards Quantity of raised bollards? Number of columns? Quantity of new "Pacific Pride" logos requested? Is existing fascia smooth with no reveals? Will new bottom trim 1"x4" be required? Will new fascia back supports be required? If any, what is the requested 11" custom fascia lettering for the canopy? tes/misc. Canopy Information: Draw detail of fascia to include gutter dimensions (& previous fascia height, if existing) If canopy deck or gutter is damaged, include exact dimensions for replacement parts along with quantities. PP Survey, Pacific Pride Material Survey Form updated xlsm, 8/1/211, 4 of 7

Primary Sign Single Face Sign SIGN MOUNT TYPE Double Face Sign Center Mount Dual Mount

Terminology Square Corner Radius Corner Hanging Bar Exterior Hanging Bar Interior

Dimensions (Optional for Retail Sites only) Total Length of Track Is "Tenths": (Check

Face Properties: Main ID Pan Formed (Check One) -Depth Sgl or Dbl Face (Check One) Sgl

5 Primary Sign Single Face Sign SIGN MOUNT TYPE Double Face Sign Center Mount Dual Mount Flag Mount Wall Mount Swing Mount Monument Cabinet Corners (Check One) Sign Terminology Square Corner Radius Corner Hanging Bar Exterior Hanging Bar Interior Hanging Bar Illumination (Check One) Internal External n-illuminated LED Numeral Plate Dimensions (Optional for Retail Sites only) Total Length of Track Is "Tenths": (Check One) Decorated on Face A Placard Is "Tenths" Indicated As: (Check One) Small 9 As 9/1 Face Properties: Main ID Pan Formed (Check One) -Depth Sgl or Dbl Face (Check One) Sgl Face Sign Sign Verbage PP Survey, Pacific Pride Material Survey Form updated xlsm, 8/1/211, 5 of 7

Face Properties: Pricer Pan Formed (Check One) -Depth Sgl or Dbl Face (Check One) Sgl Face Sign Sign Verbage Face Properties: Message Pan Formed (Check One) -Depth Sgl or Dbl Face (Check One) Sgl

6 Face Properties: Pricer Pan Formed (Check One) -Depth Sgl or Dbl Face (Check One) Sgl Face Sign Sign Verbage Face Properties: Message Pan Formed (Check One) -Depth Sgl or Dbl Face (Check One) Sgl Face Sign Sign Verbage Face Properties: Auxiliary Pan Formed (Check One) -Depth Sgl or Dbl Face (Check One) Sgl Face Sign Sign Verbage Total Length of Track Alpha-Numeric Plate Dimensions (If Applicable) Individual Plate Width May Vary Depending on Verbage (copy) PP Survey, Pacific Pride Material Survey Form updated xlsm, 8/1/211, 6 of 7

7 Retainer Properties Column and Base Plate Dimensions Column Height Overall Height NOTE: Overall Height Measured From Top of Sign to Grade. Base Plate Thickness Foundation (Check One) Direct Burial Anchor Bolt 4 Bolt Measurements Bolt Diameter 6 Bolt Measurements Bolt Diameter General Pole Information Round Pole(s) Diameter Tube Pole(s) Dimensions x PP Survey, Pacific Pride Material Survey Form updated xlsm, 8/1/211, 7 of 7

VERIZON INDIRECT AGENT SMART STORE FIXTURE CATALOG

VERIZON INDIRECT AGENT SMART STORE FIXTURE CATALOG Palmer Promotional Products Fraser, MI 48026 586.772.4225 www.vzwcoop.com [ you will find us listed under co-op vendors/fixtures ] INDEX Item Example