Wisconsin functionality verification: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin with Section A: OWNER INFORMATION. Fill in your name and company name, followed by the SITE INFORMATION, including Facility ID#, Facility Name, and Site Address.
Next, complete the CONTRACTOR INFORMATION section. Provide the contractor's name, contact person, address, email, and phone numbers.
In Section B: Results of Testing/Servicing, enter the technician’s Manufacturer’s Certification Number and details about all equipment tested. Indicate if deficiencies were corrected and provide comments as necessary.
Proceed to Section C: Inventory of Tank Equipment. Check the appropriate boxes for each tank product and ensure all required sensors are functioning properly.
Continue through Sections D to G, ensuring all questions are answered accurately regarding overfill systems, containment measures, general monitoring system checks, and dispenser information.

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