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Work Order. 2283696 <br /> (FSO)&(FSV)Temng Forth-Version I-625f"7 <br /> Emergency Shut Off (ES®) & <br /> Dispenser Emergency Shutoff Valve (ESV) <br /> ANNUAL TEST RECORD LOCATIONS AND TEST DATA <br /> Testing ,,- /' ( <br /> Company: 7r"/-V M NO L0 t� y Date: <br /> Location Name: C�. �L� _ Store#-. nv/I05' Sta&ID#: <br /> Adan,,: Cay: '4 7*V1 state: C <br /> Emergency Shut Off(ESO) Testing Results <br /> OHO-fir/-// in accordance with"ESO Vendor Letter(3-71-05).doe',from Valero's Retail <br /> Compliance Department,as a part of annual compliance testing,this representative tested the <br /> Emergency Shut Off(ESO switches indicated on this sketch.Findin listed below: <br /> Emergency Shut Off(ESO) If No,Provide <br /> Operationar &N Ma'udenance Log# Date Cafled <br /> Dis enser Emergency Shutoff Valve S Tosting Results <br /> On •/ -// 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.Findings listed below: <br /> Dish.Emergency Shut Off if No,Provide <br /> Valve(ESV)Opemtionai? N Maintenance Log# Date Called: <br /> Site Map(fflUicetion and Placement of ices Teased: <br /> Syo,e� <br /> b6 0 <br /> oo L <br /> Sienature Of Representative: <br /> Tanknology Inc. 11000 N.MoPac Expressway,Suite 500,Austin,Texas 78759 <br />