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Work Order:' 2277185 <br />(FSO) & (ESV) lesiing Form - Version I- 10'7:2010 <br />Emergency Shut Off (ESO) & <br />Dispenser Emergency Shutoff Valve (ESV) <br />ANNUAL TEST RECORD LOCATIONS AND TEST DATA <br />Emergency Shut Off (ESO) Testing Results <br />On in accordance with 'ESO Vendor Letter (3 -2 1 -05).doc", from Retail Compliance <br />Department, as a part of annual compliance testing, this representative tested the Emergency Shut Off <br />50) switches indicated on this sketch. Findings listed below: <br />T - <br />Dis en er Emergency Shutoff Valve ESV TestingResults <br />On /o /o in accordance with NFPA 30A this representative tested the automatic -closing feature <br />of the Dispenser Emergency Shutoff VAL'v'E(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 automaticallyclose. Findings listed below: <br />Site Map U1 Locution and Placcmcm of De6ces Te.trd <br />;�O N G 7^ T �`�7bD - <br />Signature Of Representative: Testing TANKNOLOGY 1U -8 -IU <br />company: Date: <br />Location Name: 7 -ELEVEN Store #: l �I7fi State ID #: <br />Address: I3'�51?'i. MAIN ST City: :VIAT�iTF.L':� State: <br />Emergent} Shut Off' (ESO} <br />!f No, Provide <br />if No, Provide <br />Operational'? <br />� N <br />.'Maintenance Log # <br />Date Called <br />Maintenance Log # <br />CA <br />Emergent} Shut Off' (ESO} <br />!f No, Provide <br />if No, Provide <br />Operational'? <br />� N <br />.'Maintenance Log # <br />Date Called <br />Maintenance Log # <br />Disp. Etnergenc7� Shut Off <br />if No, Provide <br />Valve {ESV) Operational'' <br />� <br />Maintenance Log # <br />Date Called <br />Tanknology Inc. 11000N. MoPac Expressway, Suite 500, Austin, Texas 78759 <br />