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Work Order: 2264212 <br /> WSO)K.(F.SVI lesiinpFol'11 <br /> Emergency Shut Off (ESO) & <br /> Dispenser Emergency Shutoff Valve (ESV) <br /> ANNUAL TESTRECORD LOCATIONS AND TEST DATA <br /> 71141 <br /> 1.0caliori Name* C�(_Adp fro Store#: State Ill n: <br /> nc- <br /> (I d r es S: State: I CA <br /> Emereenev Shut Off(ESO) Testing Results <br /> On 3/ in accordance with "ESO Vendor Letter(3-21-05).doe", from Retail <br /> CoinpHance Department, as a part of annual compliance testing,this representative tested the <br /> Driel-gericyShut Off(ESO) switches indicated on this sketch. Fin <br /> dings listed below. <br /> F'T11eJ_1"Ct1L'N1 S1101 Off(I-I'SO) <br /> If No,Provide <br /> Maintenance Lag,# Date C4111ed: <br /> Dispenser Emergency 53hutoff Valve (ESV) Testing Results <br /> 011 -31'oel - <br /> in accordance with NFPA 30A this representative tested the automatic-closl fig Jbaft',rc <br /> Dispetiser E.nicrpncy ShL toff VALVES)(ESV) located in the supply lines at the base of each <br /> A <br /> individlual island Cypc dispenser ndicated on the diagr= below. Each device <br /> N01-d OU'umatIcallv close.e. Fin <br /> di as listed below- <br /> Disp. 1. =rliicv Shut Off <br /> If No,Provide <br /> Maintenance Log <br /> 'N <br /> It Date Called <br /> Sl�o 4:11"t)�k-wation and Placenwrit ol'Dvvict gTeMud: <br /> to _U <br /> e,5- <br /> AA <br /> All <br /> Silynature Of'Representative: ;z <br /> Tanknology Inc. 8501 N.MoPac Expressway,Suite 400,Austin,Texas 78754 <br />