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Work Order: 2277281 <br /> (ESO)&(ESV)Taft rwia-Vmion 1-10/13/2010 <br /> Emergency Shut Off(ESO) & <br /> Dispenser Emergency Shutoff Valve (ESV) <br /> ANNUAL TEST RECORD LOCATIONS AND TEST DATA <br /> Testing TANKNOI.OGY O '� '.p <br /> Company: Date: �/ <br /> I.a:atlon Name: ID I u� Store#: �/70iState ID#: <br /> Address: L 1OOAMM <br /> City: State: l� <br /> Emerp-ency Shut Off SO Testing Results <br /> On 10114110 in accordance with"ESO Vendor Letter(3-21-05).doe",from Retail Compliance <br /> Depahmdnt,as a part of annual compliance testing, this representative tested the Emergency Shut Off <br /> ESO switches indicated on this sketch.Fmdin s listed below: <br /> Emergency Shut Off(ESO) If No,Provide <br /> Operational? I y ;N I Maintenance Log# I I Date Called <br /> Dispqgsqr Emergency Shutoff Valve (ESD Testing Results <br /> On in accordance with NFPA 30A this representative tested the automatic-closing feature <br /> of the Emergency Shutoff VALVE(S)(ESV)located in the supply lines at base of each <br /> individual island type dispenser indicated on the diagram below.Each device(#) 4 in all, <br /> would automatically close. F' listed below: <br /> Disp.Emergency Shut Off If No,Provide <br /> Valve(ESV)Operational? Y- N Maintenance Log# Dau Celled <br /> Site MWOf[uwtioo and% [ofDevices Tesfad: <br /> (J <br /> Signature Of Re�resentstive• <br /> Tanknology Inc. 11000 N.MoPac Expressway,Suite 500,Austin,Texas 78759 <br />