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RECEIVED <br /> (ESO)&(ESV)Testing For <br /> FEB 2 2 2016 <br /> Emergency Shut Off (ESO) & ENVIRONMENTAL <br /> Dispenser Emergency Shutoff Valve (ESV) HWTH nWPARTMENT <br /> ANNUAL TEST RECORD LOCATIONS AND TEST DATA <br /> Testing ( i <br /> Company: f r J c P J`�.�� ,._ Date: j <br /> Location Name: Store#: State ID#: <br /> Address: 01 (,J . S� . City: State: <br /> Emergency Shut Off(ESO) Testing Results <br /> On 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 /> (ESO) switches indicated on this sketch. Findings listed below: <br /> Emergency Shut Off(ESO) If No,Provide <br /> Operational? � WN Maintenance Log# Date Called <br /> Dispenser Emergency Shutoff Valve (ESV) Testing Results <br /> On ►-aS-1 e 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 at the base of each <br /> individual island type dispenser indicated on the diagram below. Each device(#) in all, <br /> would automatically close.Findings listed below: <br /> Disp.Emergency Shut Off If No,Provide <br /> Valve(ESV)Operational? CDY N I Maintenance Log# Date Called <br /> Site Map Of Location and Placement of Devices Tested: <br /> Signature Of Representative: n r-c LA d c) <br />