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Work Order: 2279543 <br /> (ESO)&(ESV)Testing Form-Version 1-2/16/7-1011 <br /> Emergency Shut Off (ESO) <br /> Dispenser Emergency Shutoff Valve (ESV) <br /> ANNUAL TEST RECORD LOCATIONS AND TEST DATA <br /> Testing <br /> Company: Date: "d/ <br /> Location Name: -L Store#: ;2O 32 StatelD#: 7-'/3/qo <br /> Address: e,% I City: State: <br /> Emergency Shut Off(ESO) Testing Results <br /> On ;7- in accordance with"ESO Vendor Letter(3-21-05).doc",from Valero's Retail <br /> Compliance Department,as a part of annual compliance testing,this representative tested the <br /> Emergency Shut Off ESO switches indicated on this sketch. Findings listed below: <br /> Emergency Shut Off(ESO) I If No.Provide <br /> Operational? I Y/N I <br /> Maintenance Log# 1Date Called <br /> Dispenser Emergency Shutoff Valve (ESV) Testing_Results <br /> On 9-(7-(/ 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? N Maintenance Log# Date Called <br /> Site Map Of Location and Placement of Devices Tested: <br /> u <br /> �SIV--2, <br /> 13 <br /> Signature Of Representative: <br /> Tanknology Inc. 11000 N.MoPac Expressway,Suite 500,Austin,Texas 78759 <br />