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Work Order: 2272110 <br /> dM <br /> Now <br /> (IISO)&(ESV)Tcsting Pomt-Version 1-10/1'.'2009 <br /> Emern;ency Shut Off (ESO) & <br /> Dispenser Emergency Shutoff Valve (ESV) <br /> ANNUAL,TEST RECORD LOCATIONS AND TEST DATA <br /> Testing TANKNOLOGY 3 <br /> !jgompany: ...._. _Date•_-1 i f- (Q --- <br /> Location Name: G Le Ell d®®f7 Store#: , $4 Q State ID#: <br /> i tri _-- <br /> Address:...___ 13 �q E. �.kA'f e� t'UO �C�__! C'.t?'.._.._1_.__. ' G--- <br /> _ _ _J <br /> Emergency Shut Off(ESO) Testing Results <br /> On 2•(1-(U in accordance with"ESO Vendor Letter(3-21-05).doe". from Retail Compliance <br /> Department,as a part of annual compliance testing,this representative tested the Emergency Shut Old' <br /> (ESO)switches indicated on this sketch. Findings_listed below: <br /> Emergency Shut Off(ESO) T If No,P,-Ovid— <br /> Operational? N Maintenance Log# Date Called : <br /> I_.. �___.. <br /> Dispenser Emergency Shittoff Valve (ESV) Testing Results <br /> On -2- 0- (O in accordance with L14FPA 30A this representative tested the automatic-closing feature <br /> of the Dispenser Emergency Shutoff VAVE(S)(ESV)located in the supply lines at the base of each <br /> individual island type dispenser indi,.ated on the diagram below. Each device(#) ���in all; <br /> would automatically close. Findings listed below: <br /> D€sp.Emergency Shut Off If No,Provide <br /> Valve(ESV)Operational? N + Maintenance Log# Date Called <br /> i <br /> Site Map Of l,=tion and Placement of l)nices Tes ed: <br /> 0 e(7+ <br /> _L <br /> G XS <br /> LOJ <br /> o a p <br /> Cl I <br /> a <br /> i @s® o <br /> ' p D <br /> t <br /> 1 <br /> � iso <br /> i <br /> (f S4ore <br /> Signature Of Representative: <br /> Tanknology Inc. 11000N.MoPac Expressway,Suite 500,Austin,Texas 78759 <br />