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COSTC0, Emergency Stop Switch Operation Inspection <br /> WMIME "E <br /> Facility: Costco#658 Tracy Date: 9/26/19 <br /> Address: 3250 W. Grant Line Rd. Testing Company: Alltech Petro Inc. <br /> City, State,Zip: Tracy, Ca Tester Name: Chad White <br /> This procedure is to verify the operation of all emergency stop switches/buttons(E-stops). Each E-Stop must <br /> disconnect power to the dispensers,submersible turbine pumps (STPs)and all non-intrinsically safe electrical equipment <br /> in classified areas. Test each E-Stop separately. See PEI/RP1200,Section 11 for the inspection procedure. <br /> E-Stop Number or ID 1 2 <br /> Location On Data Hut West side of Station <br /> 1. E-stop labeled and located ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No <br /> where easily accessible? <br /> 2.System is fully powered and in ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No <br /> normal operating condition? <br /> 3.After activating E-stop, power has been disconnected from: <br /> 3a.All dispensing devices on all ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No <br /> islands? <br /> 3b.All STPs for all fuel grades? ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No <br /> 3c.All power,control and signal <br /> circuits associated with the ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No <br /> dispensing devices and the <br /> STPs? <br /> 3d.All other non-Intrinsically safe <br /> electrical equipment in classified ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No <br /> areas surrounding fuel <br /> dispensing devices? <br /> 4.All intrinsically safe electrical <br /> equipment remains energized ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No <br /> after E-stop activation? <br /> 5. After testing, has E-stop been <br /> reset and power reestablished to ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No <br /> normal operating condition? <br /> A"No"to lines 3a-3d indicate a test failure. <br /> Test Results: ® Pass ❑ Fail ® Pass ❑ Fail ❑ Pass ❑ Fail <br /> Comments: <br /> Tester's Signature Date: 9/26/19 <br />