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Work Order: 2254768 • • <br /> (ESo)&(Esv)'1'emma Form-version 1-I13 'IN, <br /> LERO <br /> Emergency Shut Off (ESO) & <br /> Dispenser Emergency Shutoff Valve (ESV) <br /> ANNUAL TEST RECORD LOCATIONS AND TEST DATA <br /> Testing .r <br /> Comy_an : �i Date: , ---'- _ ...---- <br /> Lowtioa Name: ��� Store#: Slate ID#: <br /> Address: �� r��- City: ! :.t_ State: <br /> ElneEgency Shut Off ESO Testing Results <br /> On in accordance with"ESO Vendor Letter(3-21-05).doe',from Valero's Retail <br /> Compliance Department,as a part of annual compliance testing,this representative tested the <br /> Emergency Shut Off ESO switches indicated on this sketch.Findin listed below: <br /> Emergency Shut Off(ESO) If Vo,Prode <br /> Operational? '( Maintenance[.viog t: I Date Called: <br /> Dis enser Emervency Shutoff Valve (ESM TestinLy Results <br /> On a ' 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 at3be base of each <br /> individual island type dispenser indicated on the diagram below.Each device(#) in all, <br /> would automatically close. Findin listed below: <br /> Disp.Emergency Shut Off IfVo,Provide <br /> Valve(ESV)Operational? N Maimen 'ro Log# Date Called: <br /> Sia Map Oft.nr+tim and PL,� tuftkric T..ad: n - <br /> ! y� nw <br /> � s <br /> Signature Of Reoresentative- <br /> Tanknology Inc. 8501 N.MoPac Expressway, Suite 400,Austin,Texas 78759 <br />