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by GR Job# 18201789 X4J Emergency Shut-Off (ESO) Testing Results & Checklist Facility Information Contractor Information TEST Results Site#Arco 7149 Co. Name: Gettler-R an Inc. Date:6/2 0/2 018 Address: Phone 925-551-7556 9484 West Lane Lead Technician:David Rouse x PASS City/St:Stockton, CA Name: _ or eMaint.W.O.# 1 5 5 Passport: FAIL(Next Day Repair Required) Signature The objective of this test Is to provide assurance that the when the E-Stop switch is activated,all the fueling system clrcults(turbines,and dispensers)are de-energized,an remain de-energized until they are re-set manually). The test procedures and guidelines shall be In accordance with the Estop Testing Process. # The following Information/s to be completed. X To select Ya No A SITE DATA 1 Number of E-Stopswitches: 1 2 Type of Switch? Push Pull_U MomentaryPlain light/Toggle]EL Other: (if Momentary type, locate and identify re-set button): In Elect Room 3 Type of Turbine Control Relay System (Electrical Distribution Center): 11 Brown Box 0 Power Solution -M Other Custom Fabricated a T e of Turbine Control Relays: Make R d Model 2-1 1 5 1 Type of Line Leak Detection: Mechanical ELD/CPT V I PLLD PERFORMANCE TEST 6 Does the E-Stop shutdown power to the DISPENSERS 7 Does the E-Stop shutdown power to the TURBINES X 8 Is the 220 voltage to the turbine relay removed(either the line side or the motor side of the contacts or the coil)? :,,t 9 Are the DISPENSER BREAKERS clearly identified/labeled? A 10 Are the TURBINE BREAKERS clearly identified/labeled? 11 Are all the ESOs accessible and clearly identified/labeled? X ; 12 Did the ESO(s)function correctly(de-energized from either the line side or the motor side of the contacts or the coil)? X 12A If#12 is NO, briefly describe what was wrong: 128 How was it corrected: 12C If repair or ESO functionality cannot be corrected same da .r. p y y(prior to leaving the site). The technician MUST notify the ' Y T Site Manager of the problem, place an"Out of Service"Tag on the ESO(s), and identify an alternate mean (i.e., locate circuit panel, clearly identify turbine and dispenser breakers for shut-off in the event of an emergency). 12D Elite Customer Solution Center has been contacted for the repair. eMaint.W.O.Ticket# POST TEST 11 Site's fueling system is fully operational. x 12 JAII equipment secured and any access ports, lids, enclosures are closed. x s� 13 JAII safety barricades,and any debris was been removed. x ".r COMMENTS ; JUL 13 2Q18 ENVIRONMENTAL HEALTH LGP RTn..IENT Submit completed copy with other documentation in E-Maintenance.