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rO Emergency Stop Switch Operation Inspection 1 RIMESALE Facility : Costco # 1031 Manteca Date : 08/ 13/ 19 Address : 2440 Daniel St . Testing Company : Alltech Petro Inc . City , State , Zip : Manteca , Ca Tester Name : Isaac Anderson This procedure is to verify the operation of all emergency stop switches/buttons ( E-stops ) . Each E -Stop must disconnect power to the dispensers , submersible turbine pumps ( STPs ) and all non - intrinsically safe electrical equipment in classified areas . Test each E -Stop separately . See PEI/RP1200 , Section 11 for the inspection procedure . E- Stop Number or ID 1 2 3 Location On Data Hut South side of Station 1 . E-stop labeled and located ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No where easily accessible? 2 . System is fully powered and in ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No normal operating condition ? 3 . After activating E -stop , power has been disconnected from : 3a . All dispensing devices on all ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No islands? 3b . All STPs for all fuel grades? ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No 3c. All power, control and signal circuits associated with the ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No dispensing devices and the STPs? 3d . All other non- Intrinsically safe electrical equipment in classified ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No areas surrounding fuel dispensing devices ? 4 . All intrinsically safe electrical equipment remains energized ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No after E-stop activation ? 5 . After testing , has E-stop been reset and power reestablished to ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No normal operating condition? A " No " to lines 3a-3d indicate a test failure . Test Results : ® Pass ❑ Fail ® Pass ❑ Fail ❑ Pass ❑ Fail Comments : RECEIVED AUG ' 8 G ` 9 ENVIRONMENTAL HEALTH Tester's Signature Date : 08/ 13/ 18