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. W ork'Order: 2259273 <br />(ESO) & (ESV) Testing Fomn - Version 1- 9/12008 <br />Emergency Shut Off (ESO) <br />Dispenser Emergency Shutoff Valve (ESV) <br />ANNUAL TEST RECORD LOCATIONS AND TEST DATA <br />Testing TANKNOLOGY —5 z, 6 (o 'o <br />Company: Date: <br />Location Name: C®17Q c® l <br />Emergency Shut Off ESO TestingResults <br />On 2 G Q in accordance with "ESO Vendor Letter (3-21-05).doe', from Retail Compliance <br />Department, as a part of annual compliance testing, this representative tested the Emergency Shut Off <br />ESO switches indicated on this sketch. Findings listed below. <br />Dis enser Emer enc Shutoff Valve ES TestingResults <br />On Z 0'6 in accordance with NFPA 30A this representative tested the automatic -closing feature <br />of the ispenser 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 (#) 1 S in all, <br />would automaticall close Findin listed below: <br />Site Map Of Location and Placement of mices Tested: <br />�G <br />IYKIO <br />Q <br />Signature Of Representative: <br />'7 <br />P <br />Store #: G�Q 5�� State ID #: �. A <br />Addre <br />Emergency Shut Off (ESO) <br />If No, Provide <br />Operational? <br />� <br />Maintenance Log # <br />ss: � <br />City: <br />5 017 <br />State: <br />(tel' <br />Emergency Shut Off (ESO) <br />If No, Provide <br />Operational? <br />� <br />Maintenance Log # <br />Date Called <br />Disp. Emergency Shut Off <br />If No, Provide <br />Valve (ESV) Operational? <br />� <br />Maintenance Log # <br />Date Called <br />Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 <br />