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Work Order: 2264099 <br /> IN <br /> Emergency Shut Off (ESO) & <br /> Dispenser Emergency Shutoff Valve (ESV) <br /> ANNUAL TEST RECORD LOCATIONS AMID "WEST DATA <br /> C-0 <br /> Date: <br /> Location NanieStore#: Stale 11)4: <br /> Address: City- State: C'A <br /> EmerLyency Shut Off(ESQ) Testing Results <br /> k)n in accordance with "ESO Vendor Letter(3-21-05).doe", from Qetad <br /> Compliance Dcpartment, as a part of annual c_�__ompliance testing, this representative tested the <br /> Dlierocncy,Shut Off(ESO)switches indicated on this sketch. Findings listed below: <br /> - -,,--Z;� .............. <br /> shu(Off(ESO) If No,Provide <br /> Da I <br /> 60 N I Maiatenauce I Date Ca led <br /> Pis eraser Einer encs Shutoff Valve ESV Testing Results <br /> in accordance with NFPA 30A this representative tested the automatic-closim, f'caturc <br /> o C thc Disnenser Emergency Shutoff VAINE(S) (ESV) located in the supply lines at the lase of'cacl-, <br /> individwill island type dispenser indicated on the diagram below. Each device(fl) - in all, <br /> If <br /> would automatically close. Ii Findings <br /> I g listed below: <br /> Disp. Fr:iergejcy Shat.{)ti' <br /> If No'Provi(le <br /> Valve(I-:SV)0,,)crafiojiaI? Lag Date Callrd : <br /> A" <br /> A.A A <br /> 444 AAA �0 <br /> Signatui-e Of Representative <br /> Tanknology Inc. 8501 N.MoPac Expressway,Suite 400,Austin,Texas 78759 <br />