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LAddres�i <br /> h(Vear <br /> Inspection Checklist <br /> Station Na� cCoaxial(2-Point Phase I and.Balance Phase II Vapor Recovery >ystemsFacility <br /> --- stem—— - — — - <br /> This form was designod for use at stations with inspection turned up equipment d,ifocts or other issues reVulnng further actionretailed to the rioted repairs with the Lcv Keep these recons <br /> Coaxial or 2-Point Phase I with Balance Phase 11 Recer0descriptions of the note,I i0ects and repairs on the Daily Repair Log accussible In the Operations&Maintenance Manus for inspection <br /> vapor recovery systems. Place aCheck mark in .Record your initials at the bonuni of the form after completing each day's by the Air Pollution Control District lot a period of at least two years <br /> each box where your inspection revealed no inspection Keep copies of work orders and/or equipment part receipts <br /> ptoblems.and an-X-in each be.wherd your <br /> • Day of the Month <br /> (Use TRAFFIC CONES and SAFETY VESTS) [1=2 314151617 6 9 t .� 11 12 13 1415 16 17 18 19I20121122123L4 26 26 27 2$29 30 <br /> TANK AREA <br /> I Vent line.PV Valves)present yellow sticker,no vapor shadows ✓ � � ✓v V % <br /> 2 Spill containers-clean and dry IV Vk/ VV/ <br /> 3 Spill cr.ntainer drains operative and closed.chain attached(it applicable) _. _... ._ ..__ __ ✓ _. i v✓ _ ✓ <br /> x Vapor ups gaskets present R light,cops not missing, broken or Bose V <br /> 5 Vapor adapters-tlghf on nser dry break poppet is not mrssing/demagod AVV J 1/ t/ ✓ ✓f <br /> s Fill ups-gaskets present and light.caps not miss4hg broken or loose _ <br /> 7_Fill adapters attached tightly to nser,inside gasket not missing or tom V V/ f NV — <br /> to <br /> Ve Fill tube(coaxial spring-loaded)presenronin spring no(broken or sagging g Coaxial gasket in place.seals g vapors J y — _ --Fill tube-(2-Pomf)present ro rid __. <br /> DISPENSER AREA _ <br /> 1 I Ah district decals legible oper+fury ms(i r'(ons.correct complaint phone a _- <br /> 12 Hoses CARB approved. no kmks4earsysbla. LRD Installed correctly V P <br /> u Breakaways CARB-approved.no liquid stainldusf buildup ✓ ✓ V <br /> 14 Nozzles-CARB-appmved,has all clamps, swivels work smoothly.no leaks ✓ `/ ✓ V v • <br /> 15 Nozzle hold-open latches present and operating correctly V <br /> V.. _- _. _ _. <br /> 15 Nozzle bellows and laceplales tight on nozzle.no tears/slits,good seal J V ✓ <br /> _— _ - _ <br /> If Nozzle spouts not loose,net out-of-round,have latch devices <br /> is Nozzle vapor valves no vapor shadows emltang from nozzle V IV V v,V V v/ <br /> 1a Hose Retractor-present with a f 0"or less hose loop unless LRD present V y <br /> INSPECT AT LEAST ONCE PER WEEK _ <br /> 20. Drain vapor hose to remove exp sive gasoline <br /> INSPECTOR'S INITIALS: <br />