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Work Order: 2255312 <br /> (ESo)&(ESV)Testing Form-Version I-1/30/2007 <br /> Emergency Shut Off(ESO) <br /> Dispenser Emergency Shutoff Valve (ES') <br /> ANNUAL TEST RECORD LOCATIONS AND TEST DATA <br /> Testingm — Date: <br /> Coan : �� <br /> Location Name: ✓L <br /> Store# /f/ State ID#: <br /> Address: <br /> 93 City: J�iidr State: <br /> Elmer enc Shut Off ESO Testin YResults <br /> On --?gyp—OF in accordance with"ESO Vendor Letter(3-21-05).doe',from Valero's Retail <br /> Compliance Department,as a part of annual compliance testing,.this representative tested the <br /> Enver enc Shut Off ESO)switches indicated on this sketch.Fndin s sted below: <br /> Emergency Shut Off(ESO) If No,Provide <br /> Operational? 3t Maintenance Log# =1, <br /> alled <br /> Yf <br /> Dispenser Emergency Shutoff Valve (ES''V) Testing 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(4) <br /> in all, <br /> would automatically close.Findin listed below: <br /> Dis .Enver enc Shut Off If No,Provide <br /> P y Date Called: <br /> Valve(ESV)Operational? Y';;'`N- Maintenance Log# <br /> F-771 <br /> Site NL�p Ut Locution and Plucement orDevices Tested: <br /> ---------um-- <br /> Signature <br /> tYSi nature Of Re resentative: •^' <br /> Tanknology Inc. 8501 N.MoPac Expressway,Suite 400,Austin,Texas 78759 <br />