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r` Emergency Shut -Off (ESO) Testing Results & Checklist <br />Facility information Contractor Information Test Results <br />Site # Co. Name: Date: 1 c)-";;7 1 <br />Address: Phone: <br />CitVISt ) c^ r .a.� `l LeadTechn' ian: -" /• L ,e PASS <br />eMaint W.O. # Name: or <br />Pa rt #: FAIL (Next Day Repair Required) <br />The objective of this test Is to provide assurance that when the pC switch is Wthm ed, as the flmthtg system circuits gurbines, and dispensers) are de-enerrilied, and remain dee Wtilmd <br />until they are resat mmuorlly. The tee procedures and guidelines shah be In accordance with the ESO Testing Process. <br />9 rhafbrelvr kiorwatmn1%t becow XTo sated <br />� prB(a� Yrs <br />SITE DATA <br />1 Number of ESO switches: �- <br />2 TypeOfSwitch: _Push full -s! Momentary ___PWn light/ Toggle Other:( ) <br />QI' Momentary type, locate and identify re -set button): <br />3 Type of Turbine Control Relay System (Electrical Distribution Center): <br />_Brown Boit _Power Solution Custom Fabricated Cwollna Box Other <br />4 Type of Turbine Control Relays: Make Model <br />5 Type of line Leak Deieetion:^Mechanical __F-LDfCPT .�PLLD <br />PERFORMANCE TEST <br />6 Does the FSO shutdown power to the DISPENSERS? <br />7 Does the ESO shutdown power to the TURBINES? <br />8 Is the 220 voltage to the turbine relay removed (either the One side or the motor side of the contacts or the coil)? <br />8 Are the DISPENSER BREAKERS clearly Identified 1 labeled? <br />10 Are the TURBINE BREAKERS clearly Identified / labeled? <br />11 Pie all the ESOs accessible and dearly identified / labeled? <br />12 Did the ESO(s) function correctly (de -energized from either the One side or the motor side of the contacts orhhe cal)? <br />12A W#12 is NO, briefly describe what was wrong: <br />12B How was it corrected: <br />12C If repair or ESO functionality cannot be corrected same day (prior to leaving the site). The technician MUST notify the Site Manager O <br />the problem, place an "Out of Service' Tag an the F..SO(s), and identify an alternate mean Q.e., locate circuit panel , clearly identfi'y, <br />turbine and dispenser breakers for shut-off in the event of an emergency) - <br />12D Ellie Customer Solution Center has been contacted for the repair. <br />eMaott W.O. Ticket# <br />POST TEST <br />11 Site's fueling system is fully operational. <br />12 Ali equipment secured and any access ports, lids, enclosures are cued. <br />13 Ali safety barricades, and any debris was been removed. <br />_ COMME ISITS <br />Submit completed copy with other documentation in E -Maintenance. <br />