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Wolk Or4er:i 2272643 AWIL dft <br /> W <br /> A WV)Testim? <br /> ShUt Off'SO) & <br /> Emergen'-.7 kE4 <br /> Dispenser Emergency Shutoff Valve (ESV) <br /> ANNUAL TEST RECORD LOCATIONS AND TEs'r DATA <br /> fjti-ng I TANKNOWGY <br /> Company- 03-0 <br /> vlto,%j Store#: a&re -state IDA: 7 <br /> Address: 1 _5.3S city: IJ state- <br /> EmeEgency Shut.Off LESS) Te AjpJesuits <br /> On in accordance with"ESO Vendor Letter(3-21-05).doe",from Retail Compliance <br /> Department, as a'part of annual compliance testing,tbj,-,representative tested the Emergency Shut Off <br /> {Er SUS switches indicated on this sketch. Findings listed below: <br /> Emergency Shut Off{F,SC11 If No.Provide <br /> Operational? ` N I Maintenance Log# Date Called-. i <br /> Dispenser,-Emergency,Shutoff Valve JESV) Testing Results <br /> On r&L4�a- rd <br /> �9_i'D acco ance with NFPA 30A this representative tested the automatic-closing fearL <br /> of the Dispenser E rnergency Shutoff VALVE(S)(ESV)located in the supply Iffies at the base of each <br /> individual island type dispenser indicated on the di=- am below. Each device(4)_./cm7- __in all, <br /> would automatically close. Findings listed below. <br /> p. bnergtmc'%,,5hu1 Off If No,Fwvld <br /> Valve(ESV)opm-ational? Maintenance I Date cs 111 ed- <br /> N <br /> 'rested: <br /> sayer4c-5v <br /> A"N 41aA, <br /> C-51"a'ce <br /> LZI—TIZ <br /> W <br /> ........................ <br /> 67. #A,4,MW tAA16 <br /> Signature Cif Representative: <br /> Tanknology Inc. 11000N.MoPac Expressway,Suite 500,Austin,Texas 78759 <br />