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Work Order: 2275703 <br /> (F5t??&(Ei5V1l'csune 1 crrn-Vusion 1-2'1?2(W <br /> IL it <br /> 4W vo;r w—vLERO <br /> Emergency Shut ff (.ESO) +& <br /> Dispenser Emergency Shutoff Valve I(EV) <br /> ANNUAL TEST RECORD LOCATIONS AND TEST DATA <br /> Testing - -- iT <br /> Company: s- Date: � <br /> Location Name: Stora`etc ! C9T f State ID#: <br /> Address: f711 + city; j _T Sfxte: �A, <br /> Emergency Shut Off(ESO) Testing Results <br /> Uri_'-_"((> in accordance with"]ES0 Vendor Lelter(3-21-05).doc"; from Valero's Retail <br /> Compliance Department, as a part of annual compliance testing,this representative tested the <br /> Hmergency Shut Off(ESO)switches indicated on this sketch__Findings listed below: <br /> Errrorgency Shut O(T(ESO)­'j ,, If No,Provide <br /> Operational'? r MainLe--nance Log# Date Called <br /> .Dispenser Emergency Shutoff Valve (ESV) Testing Results <br /> UEl in accordance with NFPA 30A this representative tested the autornatic-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(#i) 17. in a11, <br /> would automatically close. Findings listed below: <br /> I)isp. 1 me rgcncy Shut Off I 1f No,Provide I •� � i <br /> Valve(ESV)Operational'? ' , Maintenancc lnate Called <br /> Si1c Map U7 U"tim and PIacL-mcnt oi'0c%1ccs Tested: <br /> i <br /> I <br /> i I <br /> Signature Of Rettreseotative: <br /> Tanknology Inc. 11000 N.MoPac Expressway,Suite 500,Austin,Texas 78759 <br />