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Work Order: 2279646 <br /> (ESO)&(ESV)Testing Form-Vussion]-10/13/2009 <br /> Emergency Shut Off (ESO) & <br /> Dispenser Emergency Shutoff Valve (ESV) <br /> ANNUAL TEST RECORD LOCATIONS AND TEST DATA <br /> Testing TANKNOLOGY <br /> Company: '] r Date: <br /> Location Name: !` I$ e1, Store 4: Iq <br /> !! 1 state ID#: <br /> Address: g'7� �' <br /> 5 ZttVlf CI(A City: STsx4Qh state: C 14 <br /> Emerizency Shut Off SO Testing Results <br /> On ;V in accordance with"ESC)Vendor Letter(3-21-05).doc", from Retail Compliance <br /> Department, as a part of annual compliance testing,this representative tested the Emergency Shut Off <br /> (ESO)switches indicated on this sketch. Findings listed below: <br /> Eanergeney Shut Off(ESO) If No,Provide <br /> Operational? WN Maintenance Log# Date Called <br /> Dls eraser EmemenKy Shutoff Valve (Effi Testing Results <br /> On 0, it in accordance with NFPA 30A this representative tested the automatic-closing feature <br /> of the Dispenser Emergency Shutoff VALVE(S)(ESV)located in the supply lines at the base of each <br /> individual island type dispenser indicated on the diagram below. Each device(#) in all, <br /> would automatically close- Findin s listed below: __T_ <br /> D7 Emergency Shut Off If No,Provide <br /> Valve(ESV)Operational? Maintenance Log# �Dt, led <br /> Sire Map Of Location and Placement of Devices Tested: <br /> �r <br /> Si nature Of Representative: <br /> Tanlmology Inc. 11000N. MoPac Expressway, Suite 500,Austin,Texas 78759 <br />