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Work Order: 2279264 <br />(FSo)& (ESV)Testing Fonn • Vcrsinn I- 12,M17009 <br />Emergency Shut Off(ESO). <br />Dispenser Emergency Shutoff Valve (ESV) <br />AATMAL TEST RECORD LOCATIONS AND TEST DATA <br />i g TAINKNOLOGY <br />i company: Dam <br />tt <br />Lt��C_fltjolj� Yainc: ON Store g: c�t g Slate ID #�'�—i <br />' CitAddress:y: State: <br />Emler enc • Shut Ofd (E!;Q) Testtn Results <br />On _pq- ll in accordance with "ESO Vendor Letter (3-21-05).doc", frons Retail Compliance <br />Department` as a pail of annual compliance testing, this representative tested the Emergency Shut Off <br />SO switches indicated on this sltetch. Findin s listed below•. <br />Emergency Shut Off (E50) ; <br />if No, Provide <br />OperaLional7 i ) N maintenance Log # Date Called : -- <br />Disl2enser Einergency Shutoff ValYLIESVI Testing Results <br />Un ®gL -&I-il in accordance withNFPA 30A this representative tested the automatic -closing fedlurc <br />of the Dispenser Emergency Shutoff VALVE(S) (ESV) located in the supply lines at the base of each <br />individual iglmd type dispenser indicated on the diagram below. Each device (4) in a11, <br />would automatically close._ F ndin s listed below: <br />:: E7isp. Emergency Shut Off ftfNo, Provide I <br />Maintenance io # Date Called <br />j Valve (ESV) Operational. f N S <br />r,'Wap 0f! ocation and I'lat�ment of Dcvica Testcd; <br />it <br />i <br />let <br />Twavim) <br />(! o R./LA4_. 1-10(r&O K -J <br />S' ature of Re resentaflvet <br />Tanknology Inc. 11000N. MoPac Expressway, Suite 500, Austin, Texas 78759 <br />