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FORM 5
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/ / Check this box if no UNITED STATES SECURITIES AND EXCHANGE COMMISSION ---------------------------
longer subject to WASHINGTON, DC 20549 OMB APPROVAL
Section 16. Form ---------------------------
4 or Form 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB Number: 3225-0362
obligations may Expires: September 30, 1998
continue. See Filed pursuant to Section 16(a) of the Securities Estimated average burden
Instruction 1(b) Exchange Act of 1934, hours per response......1.0
/ / Form 3 Holdings Section 17(a) of the Public Utility ---------------------------
Reported Holding Company Act of 1935 or Section 30(f) of
/ / Form 4 the Investment Company Act
Transactions of 1940
Reported
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1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to
Burley, James B Envirotest Systems Corp. (ENR) Issuer (Check all applicable)
- ------------------------------------------- ---------------------------------------------- Director 10% Owner
(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- ---
246 Sobrante Way Number of Reporting Month/Year X Officer Other (specify
- ------------------------------------------- Person (Voluntary) September 30, 1997 ---- give title --- below)
(Street) ------------------- below)
Sunnyvale, CA 94086 ###-##-#### 5. If Amendment, VP Administration
- ------------------------------------------- Date of Original -------------------------------
(City) (State) (Zip) (Month/Year)
7. Individual or Joint/Group Filing
------------------ (Check Applicable Line)
X Form Filed by one
---- Reporting Person
Form Filed by more than
---- one Reporting Person
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TABLE 1 -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature
(Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In-
Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct
(Instr. 8) End of Issuer's Direct Benefi-
(Month/ Fiscal Year (D) or cial
Day/ ---------------------------- (Instr. 3 and 4) Indirect Owner-
Year) Amount (A) or Price (I) ship
(D) (Instr. 4) (Instr.4)
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
*If the form is filed by more than one Reporting Person, see Instruction 4(b)(v). SEC 2270 (9-96)
Page 1 of 3 pages
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FORM 5 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price
Security sion or action action Derivative cisable and of Underlying of
(Instr. 3) Exercise Date Code Securities Ac- Expiration Securities Deriv-
Price of (Month/ (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative
Deriv- Day/ Disposed of (D) (Month/Day/ Secur-
ative Year) (Instr. 3, 4, Year) ity
Security and 5) (Instr. 5)
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Date Expira- Amount or
--------------- Exer- tion Title Number of
(A) (D) cisable Date Shares
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Incentive Stock Option $3.3750 10/23/96 A 35,000 (1) 10/23/06 Common 35,000
(right to buy) Stock
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1. Title of Derivative 9. Number of 10. Ownership Form 11. Nature of
Security Derivative of Derivative Indirect
(Instr. 3) Securities Security: Beneficial
Beneficially Direct (D) Ownership
Owned at End or Indirect (I) (Instr. 4)
of Year (Instr. 4)
(Instr. 4)
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Incentive Stock Option 35,000 D
(right to buy)
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Explanation of Responses:
See continuation page(s) for footnotes
**Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ James Burley 11-12-97
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ------------------------------- --------
**Signature of Reporting Person Date
Note. File three copies of this form, one of which must be manually signed.
If space is insufficient, see Instruction 6 for procedure.
Potential persons who are to respond to the collection of information contained
in this form are not required to respond unless the form displays a currently
valid OMB Number.
Burley, James B Envirotest Systems Corp. (ENR)
246 Sobrante Way 9/30/97
Sunnyvale, CA 94086
(1) Options exercisable in three annual installments. Up to 33% of the options
exercisable on the first anniversary of the date of the grant, up to an additional
33% on the second anniversary of the date of the grant, and the remaining options
exercisable on the third anniversary of the date of the grant.
page 2 of 2 pages Page 2
SEC 2270 (9-96)
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