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Work Order: 2273787 <br />Emergency Shut Off (ESO) & <br />Dispenser Emergency Shutoff Valve (ESV) <br />i 7 <br />ANN _;AL TFSTI ECORD LOCATIONS AND"FEST i <br />. —DATA <br />Testing 'TANKNOLOGY <br />q2gi any: Date- go-/(-) <br />-D N3Avd <br />Location N2MC: Store I S^e! <br />ddress: --_Icily_ e: <br />Elel' genc- <br />Y Shut Off I(ESO) Testing Results <br />On Q <br />in accordance with "ESO Vendor Letter (3-22 1-05'.doc", from Retail Compi I ance <br />'I'- <br />_1 <br />Deparbrient, as a part of annual coin oliance testing, this representative tes'Led the Emergency ShiIL <br />(ESO) switches indicated on this sketch. Findings listed below: <br />Emergency Shat Off (ESM If No, Provide <br />Maintenance I..o.- 9 Date Called <br />Operational? j /V PN <br />AL��_ ......... . <br />Dispenser Eme-rgenKvy Shutoff Valve (ESV) Testincr Resuils <br />Onle �1�7' <br />_:i20jV in accordance with NFPA 30A this representative tested the automatic-closim ea: <br />:re <br />Dispenser Emergency Shutoff VALVE(S) (E,SV) located in the supply lines at the base <br />individual island type dispenser indi,-,ated on the diagram below. Each device (11) <br />1m - - - 'nal;, <br />would automatically close. 'Endings. listed below.. ------ <br />isp. Emergncpy Shut Off Nj iif No, Providesalve ESVOera Maintenance Lo <br />Date C al I c d: <br />.... ....... <br />A 03 <br />f Nv- <br />Signature Of Renresentat <br />Tanknology Inc. 11000 N. MoPac Expwy #500, Austin, Texas 78759 <br />