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WorkOrder: 2263498 <br /> (ESO)&(ESV)Testing Fmtn-Version 1-1/ ON <br /> Emergency Shut Off(ESO) & <br /> Dispenser Emergency Shutoff Valve (ESV) <br /> ANNUAL TEST RECORD LOCATIONS AND TEST DATA <br /> Testing TANKNOLOGY <br /> Cow it <br /> Date: 2-16-,o5 <br /> Loestioe Nassir Sbrc <br /> Address: E /,-H <br /> City: T/Y..G Sbte: Cep <br /> Emergency Shut Off(ESO) Testing Results <br /> On 2,/o,O S 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 /> SO switches indicated on this sketch. Find. listed below: <br /> Emergency Shut Off(ESO) If No,Provide <br /> Operational? Y!N Maintenance Log# Date Called <br /> Dispenser Emergency Shutoff Valve (ES , Testing Results <br /> On 2 fid•C)S in accordance whit NEPA 30A this representative tested the automatic-closing feature <br /> of the Dispenser Emergency Shutoff VALVES) (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 atrtotuaticall close. F• listed below: <br /> Disp.Emergency Shut Off If No,Provide <br /> Valve{ESV}Operational? Maintenance Lo # <br /> !N g Date Called <br /> Sac Map 11Locanl <br /> tion ad Paament of 3 ices'festtd: <br /> r %E3a <br /> Rp <br /> ✓=Esv <br /> e <br /> &nature Of Representative• <br /> Tanknology Inc. 8501 N. MoPac Expressway, Suite 400,Austin,Texas 78759 <br />