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(>by GR Job# 20-600041 Emergency Shut-Off (ESO) Testing Results & Checklist Facility Information Contractor Information TEST Results Site# 2186 Co. Name: Gettler-Ryan Inc. Date: 1/28/2014 Address: 3212 n California St Phone 925-551-7555 Ci /St: Stockton Lead Technician: Chris San Nicolas x PASS eMaint.W.O.# 9918380 Name: or Passport: FAIL(Next Day Repair Required) Signature The objective of this test is to provide assurance that the when the E-Stop switch is activated,all the fueling system circuits(turbines,and dispensers)are de-energized,and remain de-energized until they are re-set manually). The test procedures and guidelines shall be in accordance with the E-Stop Testing Process. # The following Information Is to be completed. x To s.t.a Y.. No N/A SITE DATA 1 Number of E-Stopswitches: 2 Type of Switch? Push Pull X Momentary_ Plain light/Toggle` Other: (if Momentary type,locate and identify re-set button): In Elect Room 3 Type of Turbine Control Relay System(Electrical Distribution Center): Brown Box _Power Solution X Other _Custom Fabricated 4 Type of Turbine Control Relays: Make Model 5 Type of Line Leak Detection: Machanical ELD/CPT PLLD PERFORMANCE TEST 6 Does the E-Stop shutdown power to the DISPENSERS x 7 Does the E-Stop shutdown power to the TURBINES x 8 Is the 220 voltage to the turbine relay removed(either the line side or the motor side of the contacts or the coil)? x 9 Are the DISPENSER BREAKERS clearly identified/labeled? x 10 Are the TURBINE BREAKERS clearly identified/labeled? x 11 Are all the ESOs accessible and clearly identified/labeled? x 12 Did the ESO(s)function correctly(de-energized from either the line side or the motor side of the contacts or the coil)? x 12A If#12 is NO,briefly describe what was wrong: 12B How was it corrected: 12C If repair or ESO functionality cannot be corrected same day(prior to leaving the site). The technician MUST notify the Site Manager of the problem,place an"Out of Service"Tag on the ESO(s),and identify an alternate mean(i.e.,locate circuit panel,clearly identify turbine and dispenser breakers for shut-off in the event of an emergency). 12D Elite Customer Solution Center has been contacted for the repair. eMaint.W.O.Ticket# POST TEST 11 Site's fueling system is fully operational. x 12 All equipment secured and any access ports, lids,enclosures are closed. x 13 All safety barricades,and any debris was been removed. x COMMENTS -tt^yam,•'„`'^vim+ ., 04 tJW1Vfl1I=N Ti r Submit completed copy with other documentation In E-Maintenance.