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MornthlYear: "7 `7 <br /> N eTi Inspection' Checklist Address: ' <br /> CoaxbV 2-Point Phase I and Balance Phase II Vapor Recovery Systems aG Ity <br /> This form was desig ned far use at stations with inspection turned up equipment detects or other issues requiring further action. related to the noted repairs with the Log. Keep these records <br /> C,oaxat.ar2-Point Phase I with Balance Phase hl Record descriptions of the noted defects and repairs on the Nally Repel Log. accessible to the Operations&Maintenance Manual for inspection <br /> vapor recovery systems. Place aChebk mark in Record your Initials at the bottom of the form after oompieting each day's by the Air Pollution Controi District for a period of at least two years. <br /> each box where your Inspection revealed no inspection, Keep copoes of work orders and/or equipment part receipts <br /> problems,and an'W'in each box where your <br /> Day of the Month <br /> (Use TRAFFIC CONES and SAFETY VESTS) 612.13 9) 0 9 'l0 <br /> TA NK AREA <br /> Is ?�attFiiin P�7 vel fe(s)"Present,yellow sUcker,no vapor shadows f J <br /> 2.'Spifl,00ntWners-clean and dry <br /> 5pdI container drains-operatrus arrd c0sed,chain afteched(if eppNkabfe) <br /> :4,--�caps=gaskets present&tight caps rrotrnissing,broken orbosev r✓ ✓ ✓ 1� `� <br /> 5 ►7apdr adapters--light on riser, dry break poppet is not missingddamaged rI ✓ <br /> w .Fill'.caps=gaskefspmwntandbght, caps nol missing broken orkose if ✓ J f <br /> 7. Fill adapters-affached lightly to riser,inside gasket not missing or torn <br /> B. Fill tube(coaxial spring-loaded)present,round, spring Vt broken or sagging <br /> s. Coaxial gasket-in place,seating vapors <br /> �o=Fill tiibe-{z Paint)present round 1 VI <br /> DISPENSER AREA 77 <br /> ti.Air dlslrlet decals-tegible operating ihs"cfkms,correct complainf phone <br /> 1;r4ses-CAfiB- obrot+ed no kinksltearsrshts, t RD instalied correcfJy ✓/ `� f_// J if / ✓ t f Ff <br /> i 3 $reakaways.-GARB=approved,no liquid stain dust buildup P/ `�`� Y f <br /> �4,-Ndzd�-G4fii9 pwmved,has aA clamps,s<uiveis work srnoottrfy, no leaks ✓/ ✓ f ✓ ✓ ✓ <br /> V L4 <br /> 15.it]orzle hold-open latches-presentarxloperaUng Px mcdY iI ✓ V/ `� `� / `�/ f'� / / ✓ <br /> `c is, lovis and faceplates.•ttghlan rroxzte,no learslsUts, good seal t/ <br /> VV <br /> No¢zlespouts=not loose,not out-&-ouW,have latch devkes �/ / <br /> m ✓ V t! <br /> C=D ii]oz�1§Jvapor valVes-no vapor shadows emiffrng from rroxzie <br /> w ig. Hose Retractor-presenl with a 10"oriess inose loop unless LRD present <br /> INSPECT AT LEAST ONCE PER WEEK <br /> co <br /> 0 2n. Drain ua r hose to rernove excEssive gasoline <br /> N <br /> \ RdSPECTOR'S INITIALS, <br /> 0 <br /> rx <br /> w <br />