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W.O.# NW1-2308868 <br />no& 6SV FIWM(v 03-2013). , <br />Emergency Shut Off (ESO) & Dispenser <br />Emergency Shutoff Valve (ESV) ANNUAL <br />TEST RECORD <br />Testing Company: <br />(-0 Date: <br />1-4cation Name; <br />Store #: <br />State ID M. <br />Address: <br />City., <br />A. LMejgena Shu _()[I-(ESQ) Te t' ]Results <br />On 14 5 in accordance with 'ISO Vendor Letter (June 201 1),doex" from Vale Retail <br />Complke4e�rtment, now CST Brands, Enc.'s Compliance DepartmentValero's <br />, and NFPA 30A, as a <br />part of annual Compliance testing, this representative tested the Emergency Shut Off (FSO) <br />button(s) indicated on Lhe diagram below. ESO must deactivate Submersible Turbine Pumps <br />(STP) and Dispensers, <br />Emergency <br />EmorgencySbUtUR(ESO) J(�)&N 11fN0,Provide <br />eratlDnal? DiueCalled : <br />21—toll-24111ul—off —IEW Maintenance Loe # <br />Onn accordance with NFPA 30A this representative tested the automatic -closing <br />feature of *t6Dispenser Emergency Shut Off Valves(s) (ESV) located in the supply lines at the base <br />of each individual island type dispenser indicated on the diagram below. Each device (#) <br />in at(, would automatically close. <br />Valve (HSS }Operational? &=Y:2N 1'�trIUVAU �.i.enaMOZ4I <br />� I Dat, Called -, I <br />Tester Name.- Tester Signature: <br />