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by GR Job# 20-643301 <br /> to*j Emergency Shut-Off (ESO) Testing Results & Checklist <br /> Facility Information Contractor Information TEST Results <br /> Site# Arco SS 2076 Co. Name: Gettler-Ryan Inc. Date: 12/15/2016 <br /> Address: 800 E.Kettleman Lane Phone 925-551-7555 <br /> C' /St: Lodi,CA Lead Technician: David Rouse x PASS <br /> eMaint.W.O.# 10075394 Name: or <br /> Passport: FAIL(Next Day Repair Required) <br /> Si nature <br /> The objective of this test is to provide assurance that the when the E-Stop switch is activated,all the fueling system circuits(turbines,and dispensers)are de-energized,and <br /> remain de-energized until they are re-set manually). The test procedures and guidelines shall be in accordance with the E-Stop Testing Process. <br /> # The following Information Is to be completed. x To select <br /> Yea No WA <br /> SITE DATA - <br /> i <br /> 1 Number of E-Stop switches: 2 �r <br /> 2 <br /> Type of Switch? Push Pull Momentary x Plain light/Toggle Other: <br /> — <br /> (if Momentary type, locate and identify re-set button): In Elect Room <br /> 3 Type of Turbine Control Relay System(Electrical Distribution Center): <br /> _Brown Box x Power Solution _Other _Custom Fabricated <br /> 4 Type of Turbine Control Relays: Make Fe Petro Model VFC <br /> 5 Type of Line Leak Detection: Mechanical ELD/CPT x PLLD <br /> PERFORMANCE TEST <br /> 6 Does the E-Stop shutdown power to the DISPENSERS x r <br /> . <br /> 7 Does the E-Stop shutdown power to the TURBINES x �"IF <br /> T, <br /> Is the 220 voltage to the turbine relay removed(either the line side or the motor side of the contacts or the coil)? x <br /> 9 Are the DISPENSER BREAKERS clearly identified/labeled? x <br /> 10 Are the TURBINE BREAKERS clearly identified/labeled? x <br /> 11 Are all the ESOs accessible and clearly identified/labeled? x <br /> 12 Did the ESO(s)function correctly(de-energized from either the line side or the motor side of the contacts or the coil)? x <br /> 12A If#12 is NO, briefly describe what was wrong: <br /> ,Y <br /> 12B How was it corrected: <br /> 12C If repair or ESO functionality cannot be corrected same day(prior to leaving the site). The technician MUST notify the Site <br /> Manager of the problem, place an"Out of Service"Tag on the ESO(s), and identify an alternate mean(i.e., locate circuit <br /> panel,clearly identify turbine and dispenser breakers for shut-off in the event of an emergency). <br /> 12D Elite Customer Solution Center has been contacted for the repair. <br /> eMaint.W.0.Ticket# <br /> POST TEST <br /> 11 Site's fueling system is fully operational. x <br /> I RED <br /> 12 All equipment secured and any access ports, lids,enclosures are closed. x <br /> 13 JAII safety barricades,and any debris was been removed. x ± <br /> COMMENTS <br /> Submit completed copy with other documentation In E-Maintenance. <br />