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PEI/RP1200 - 17 APPENDIX Cw11 EMERGENCYSTOP SWITCH OPERATION Facility Name: Owner: Address: Address: City, State, Zip Code: City, State, Zip Code: Facility LD. #: Phone #: Testing Company: Phone #: Date: This procedure is to verify the operation of all emergency stop switches/buttons (Emstops). Each Estop must disconnect power to dis- pensers, submersible turbine pumps (STPs) and all non-intrinsically safe electrical equipment in classed areas. Test each Estop sepa- rately. See PEI/RP1200 Section 11 for the inspection procedure. Estop Number or ID Location L E-stops labeled and located ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No [] Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No where easily accessible? 2. System fully powered and in ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No FEI Yes ❑ No ❑ Yes ❑ No normal operating condition? 3. After activating Estop, power disconnected from : 3a, All dispensing devices p Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No on all islands? 3b. All STPs for all fuel ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No [] Yes ❑ NO ❑ Yes ❑ NO grades? 3c. All power, control and signal circuits associat- ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ed with the dispensing devices and the STPs? 3d. All other non-Intrin- sically safe electrical equipment in classified ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes [] No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No areas surrounding fuel dispensing devices? 4. All intrinsically safe electri- cal equipment remains ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No energized after E-stop acti- vation? 5 . After testing, E-stop has been reset and power rees- ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No tablished to normal operat- ing condition? A " No" to lines 3a-3d indicates a test failure, Test Results ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail [] Pass fJ Fail Comments: Tester's Name (print) Tester's Signature pei.org i