1. (a) In addition to other requirements set by rule, statute, or other law, each registered service technician shall complete and submit “Placed in Service/Inspection Report Form rtfuel 04-2004 (Rev. 07/14)” to the department.

2. (b) A registered service technician shall furnish the following on “Placed in Service/Inspection Report Form rtfuel 04-2004 (Rev.07/14)”:

   1. (1) Name of business;
   2. (2) Full address, including city, state, and zip code;

   3. (3) A statement of the product key as either:

      1. a. Regular;
      2. b. Mid grade;
      3. c. Premium;
      4. d. Ultra;
      5. e. Diesel;
      6. f. Kerosene;
      7. g. High speed diesel; or
      8. h. Other product key;

   4. (4) The following information about the retail motor fuel devices:

      1. a. Pump number;
      2. b. Make of meter;
      3. c. Serial number; and
      4. d. Product key;

   5. (5) The following information about the test data:

      1. a. Type of test;
      2. b. Prover reading as found;
      3. c. Prover reading as sealed;
      4. d. SN number being replaced; and
      5. e. Gallons used for test; and

   6. (6) A statement of the business’s pumps as either:

      1. a. Certified; or
      2. b. Rejected.

Source. (See Revision Notes #1 and #2 at chapter heading for Agr 1400) #12424, eff 12-1-17