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Inspection Checklist Station <br /> Station Name: <br /> Coaxial/2-Point Phase I and Balance Phase II Vapor Recovery Systems Address: v <br /> This form was designed for use at stations with Inspection turned up equipment defects or other Issues requiring further action. related to the noted repalrs with the Log. Keep these records <br /> Coaxial or 2-Point Phase I with Balance Phase II Record descriptions of the noted defects and repairs on the Daily Repair Log, accessible in the Operations&Maintenance Manual for Inspection <br /> vapor recovery systems. Place aGheck mark In Record your initials at the bottom of the form after completing each day's by the Air Pollution Control District for a period of at least two years. <br /> each box where your inspectlon revealed no inspection. Keep copies of work orders and/or equipment part recelpts <br /> problems,and an"X"in each box where your <br /> Dav of the Month <br /> (Use TRAFFIC CONES and SAFETY VESTS) 1 2 3 4 5 617 18 19 j1n111 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 <br /> TANK AREA <br /> padaDtAM <br /> line PV valve(s)present,yellow sticker,no vapor shadows <br /> containers-clean and dry <br /> ontainer drains-cperadve and dosed,chain attached(If eppllcable) <br /> r caps-gaskets present&8ghz;caps not missing,broken or loose <br /> adapters-ilght on riser,dry break poppet is not missingldamaged <br /> ps•gaskets present and tight caps not missing broken or loose <br /> i <br /> Fillaotar�-QHachad tightly to riser,Inside gasket not missiingor tom_. C,:l <br /> e. Clime c k- t i rlr, <br /> I /. / A/I I I <br /> / 777/114-1 / 7 <br /> DISPENSER AREA <br /> 11.Air district decals-legible operating Instructions,correct complaint phone# <br /> 12. Hoses-CARB-approved,na klnksltears1slits,LRD Installed correctly /� j / / / <br /> 13.Breakaways-CARB-approved,no liquid stain/dust buildup j j i 1/111/1A <br /> j/ <br /> 14.Nozzles-CARB-appreved,has all clamps,swivels work smoothly,no leaks /j / / / A <br /> 15.Nozzle hold-open latxhes-present and operating correctly / <br /> 1e.Nozzle bellows and faceplates-tight on nozzle,no tears/slits,good seal / / / / / ,i / j' <br /> 17. Nozzle spouts-not loose,not out-of-round have latch devices <br /> s.Nome vapor valves-no vapor shadows emi fng from nozzle <br /> is.Hose Retractor-present with a 10"or less hose loop unless LRD present <br /> INSPECT AT i.EAST ONCE PER WEEK - <br /> 20.Drain va r hose to remove excessive esoline / / <br /> INSPECTOR'S INITIALS; / - -- .� <br />