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Work Order: 2270669 <br /> fY.S{7).fi.(E8Y)'1-aai�FON]-Voxiva 1.12r 1.2009 <br /> Emergency Shut Off (ESO) & <br /> Dispenser Emergency Shutoff Valve (ESV., <br /> ANNUAL, TEST RECORD LOCATIONS AND TEST DATA <br /> Testing TANKNOLOGY fZ_/-QC <br /> Com env: // Date: <br /> Location Name: �•.W14.-a Store#: 2JSa State 11D* <br /> Addrem: ki 3, Cily- M.0' State: C 4 <br /> Emergency Shut Off(ESD) Testing Results <br /> On /2-POS in accordance with"ESO Vendor Letter (3-21-03).duc",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. Findin s listed below <br /> Emcrgoncy Shut Off(ESO) if No,Prrnidc <br /> Op�Yational'� N MAinten:atcc Log# Date Called <br /> Dispenser Emeenc Shutoff Valve E,SV Testing Results <br /> On_2-/-p in accordance with NFPA 30A this representative tested the automatic-closing feature <br /> of the Dispenser Emergency Sbutoff VALVE(S)(ESV)located in the supply Sines at the base of each <br /> individual island type dispenser indicated on the diagram below. Each device(#) /(r in all, <br /> would sutomaticall close. F'indin s listed below: <br /> Disp.Emerg;I Shut Off If Nv.ProAde <br /> Valve(FSV)Operu1ionalY J Nv M=teoa, Lag# Date Calicd <br /> sitebtap of Lns:kt ud Ptuo Mof De im'Lmt�t <br /> [may C 1� v <br /> 'Akrr'If T J <br /> J � <br /> Siggature Of Re Presenistive: <br /> Tanknology Inc. 11000 N. MoPac Expressway, Suite 500,Austin,Texas 78759 <br />