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Work Order: 2 2 7 9 6 2 5 <br /> (ESO)&(ESV)Testing Form-Version 1-3/3/2011 <br /> Emergency Shut Off(ESO) & <br /> Dispenser Emergency Shutoff Valve (ESV) <br /> ANNUAL TEST RECORD LOCATIONS AND TEST DATA <br /> Testing TANKNOLOGY <br /> Company: Date: ZrZ� <br /> Location Name: e4wroh Store* 7-01614 State m m rrw <br /> Address: I ITf F <br /> City: 15&t4state- <br /> 1 <br /> Emergency Shut Off(ESO) Testing Results <br /> On L ltf-I I 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 /> SO switches indicated on this sketch.Findings listed below: <br /> Emergency Shut Off(ESO) If No,Provide <br /> Operational? Maintenance Log# Date Called: <br /> Dispenser Emergency Shutoff Valve (ESV) Testing Results <br /> On Z-Lvt, y 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(#) !Z in all, <br /> would automatically close.Findings listed below: <br /> Disp.Emergency Shut Off If No,Provide <br /> Valve(ESV)Operational? Maintenance Log# Date Called: <br /> Site ManLILLocation and Placement of Devices Tested: <br /> qIz <br /> Rey <br /> S <br /> Signature Of fie-presentative: <br /> Tanknology Inc. 11000N.MoPac Expressway,Suite 500,Austin,Texas 78759 <br />