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by GR Job# 20-631615 Emergency Shut-Off (ESO) Testing Results & Checklist Facility Information Contractor Information TEST e Site# 5450 Co. Name: Gettler-Ryan Inc. Date: 712812015 Address: 1617 W Fremont St Phone 925-551-7555 AUG 12 - City/St: Stockton Lead Technician: Joey Mesa x PASS eMaint.W.O.# 9984307 Name: or 11-ENVIRONMENT/J... Passport: FAIL(Next Day Repair R*EjtlSrodr?c-)Ac—gncah, Signature The objective of this test Is to provide assurance that the when the EStop switch Is activated,all the fueling system circuits(turbines,and dispensers)are de-energized,and remain de-energized until they are reset manually). The test procedures and guidelines shall be in accordance with the Estop Testing Process. # The following Information Is to be completed. x To$WW Y" No WA SITE DATA 1 Number of E-Stopswitches: 2 2 Type of Switch? Push Pull X Momentary_ Plain light/Toggle` Other: (if Momentary type,locate and identify reset button): In Elect Room 3 Type of Turbine Control Relay System(Electrical Distribution Center): Brown Box _Power Solution X Other Custom Fabricated 4 Tfpe of Turbine Control Relays: Make FE Petro Model MAG VFC 5 11pe of Line Leak Detection: Mechanical ELD/CPT X PLLD PERFORMANCE TEST 6 Does the E-Stop shutdown power to the DISPENSERS x 7 Does the E-Stop shutdown power to the TURBINES x 8 Is the 220 voltage to the turbine relay removed(either the line side or the motor side of the contacts or the coil)? x 9 Are the DISPENSER BREAKERS clearly identified/labeled? x 10 Are the TURBINE BREAKERS clearly identified/labeled? x 11 Are all the ESOs accessible and clearly identified/labeled? x 12 Did the ESO(s)function correctly(de-energized from either the line side or the motor side of the contacts or the coil)? x 12A If#12 is NO,briefly describe what was wrong: 12B How was it corrected: 12C If repair or ESO functionality cannot be corrected same day(prior to leaving the site). The technician MUST notify the Site Manager of the problem, place an"Out of Service"Tag on the ESO(s),and identify an alternate mean(i.e.,locate circuit panel,clearly identify turbine and dispenser breakers for shut-off in the event of an emergency). 12D Elite Customer Solution Center has been contacted for the repair. eMaint.W.0.Ticket# POST TEST 11 Site's fueling system is fully operational. x 12 All equipment secured and any access ports, lids,enclosures are closed. x 13 All safety barricades,and any debris was been removed. x COMMENTS Submit completed copy with other documentation In E-Maintenance.