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Work Order: 2272586 <br /> Amok <br /> (f:SO) (BSV)Tc-stingForm-Version I-10113P2009 <br /> Emc rgency Shut Off t'r.'SO) & <br /> Dispenser Eemergency Shutoff Valve (ESV) <br /> ANNUAL TEST RECORD LOCATIONS AND TEST DATA <br /> TAINKNOLOGY <br /> I <br /> 1 Company: Date: <br /> 0-Location Name: Store#: State ID <br /> Address:: &R3Y city: State: <br /> I-V_Az 4 <br /> Emerzengy Shut Off(ES())Testing RWilts <br /> 1-05).doe',from Retail Compliance <br /> On �z 3- )U .in accordance witIt"ESO Vendor Letter(3-2 <br /> Department,as a part of annual compliance testing,this representative tested the Emergency Shut Off <br /> (ESO)switches indicated on thil sketch.Findinp listed below: <br /> Emergency Shut Off(ES If No,ProvideOperationaI7 Y Maintenance Log# Date Called <br /> Dispenser Emergency S ittoff Valve (ESV) TestingResults <br /> On --�p—"3;--10 in accordance tli'NFPA 30A this representative tested the automatic-closing feature <br /> of the Dispenser Emergency Sh4toff'VALVE(S)(ESV)located in the supply lines at tbLc base of each <br /> individual island type dispenser indi,mted on the diagram below.Each device in all, <br /> would automatically close. F n In -,listed below: <br /> wisp.Emergency Shut Off vide <br /> If No,Pro <br /> Valve(ESV)Operational? Yj NMaintenance Log eCalled: <br /> d <br /> Of hocatim�4nd Fla=mt ofiloi4s Tes ed: <br /> �►K <br /> LA <br /> Ai <br /> U< <br /> 1 <br /> Signature Of Representative:, <br /> I i <br /> Tanknology Inc. 11000N.MoPac Expressway,Suite 500,Austin,Texas 78759 <br />