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Work Order: 2271873 aft 1� <br /> tF,$O)&(F_1qV)Tesbog Form-Vcniun I-12,9IMP <br /> Emergency Shut Off k'r-,SO) & <br /> Dispenser Emergenc* Shutoff Valve (ESV) <br /> -ANNUAL TEST RECORD LOCATIONS AND TEST DATA <br /> Testing TANKNOLOGY DMA: 40 <br /> Company: <br /> Store#: state TE),#p 17*&q� <br /> Location Nalue. <br /> j? <br /> Address: 5 IYAJ'r_� 5ta�pr City: j#A State: 111/4 <br /> Emergena Shut Off(ESO)Testing sults <br /> On 0 t-26-10 in accordance with"ESO Vendorletter 3-21-05),doc",from Retail Compliance <br /> Department. as a part of annual compliance testing,1this representative tested the Emergency Shut Off <br /> � O switches indicated on this sketch.-Findings,listed below-, <br /> Ernergency Shut Off(Bso) /_91\ Tf No,Fro I <br /> ( Z ajnLenaneLo.Operadonat? aP <br /> Date UW: <br /> L <br /> Dispenser Ebner enc Shutoff Valve!(ESV) Testing Rest ltS <br /> Onol-2s-1V in accordance with NFPA 3 OA thig representative tested the automatic-closing feature <br /> of the Dispenser Emergency Sbutoff VALVE(S) (IV)located in the supply lines at the base of each <br /> individual island type dispenser indicated on the di4gram below. Each device(4) in all, <br /> would aututnatiMly close. Findings 1i tod below: 1, <br /> bisp.Ernergeticy Shut Off Ii No,Pro44s <br /> 0 FValve(E-SV)Operational? ry'zN MaiutenanLog Date Cal lod=-- <br /> t S ie Map Of Loegion and of 6M Tww: <br /> J <br /> Edd <br /> zt. <br /> 14 <br /> < <br /> 1 <br /> oil- <br /> 5, 1-414:r <br /> Simature Of Representative., <br /> r <br /> Tanknology Inc. 11000N.MoPac Expressway,Suite 500,Austin,Texas 78759 <br />