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Work Order <br />2280901 <br />(ESO) & (ESV) Testing Form - Version 1- 4/29/2011 <br />Emergency Shut Off (ESO) & <br />Dispenser Emergency Shutoff Valve (ESV) <br />ANNUAL TEST RECORD LOCATIONS AND TEST DATA <br />Testing <br />Company: <br />TANKNOLOGY <br />Date: <br />�(- <br />Location Name: <br />C <br />Store #: <br />3071 <br />State ID #: <br />Address: <br />p , <br />City: <br />-0 <br />State: <br />Emergency Shut Off (ESO) Testing Results <br />On in accordance with "ESO Vendor Letter (3-21-05).doc", 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 />Emergency Shut Off (ESO) <br />IIf <br />No, Provide <br />Operational? <br />1101Maintenance <br />Log # <br />Date Called: <br />Dispenser Emereencv Shutoff Valve (ESV) Testing Results <br />On %A - '1St -1, in accordance with NFPA 30A this representative tested the automatic -closing feature <br />of the Dispenser 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 (#)_ in all, <br />would automatically close. Findings listed below: <br />Disp. Emergency Shut Off <br />If No, Provide <br />Valve (ESV) Operational? <br />Maintenance Log # <br />Date Called; <br />and Placement of Devices Tested: <br />Tanknology Inc. 11000 N. MoPac Expressway, Suite 500, Austin, Texas 78759 <br />