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Month/Year; <br /> 1-77 <br /> ins ection- checklist Addie Name:_ � Address; <br /> CaaxiaV 2-Point Prase l and Balance Phase li Vapor Recovery Systems arty <br /> This form was destg ned for use at stations with inspection turned tip equipment defects or other issues requiring further action. related to the noted repairs wish the Log, Keep these records <br /> Coaxial or 2-Point Phase I with Balance Phase If Reoord descriptions of the noted defects and repairs on the Daily Repair Log. accessible in tte Operations&Maintenance Manual for inspection <br /> vapor recovery systems. place aCheck mark in Record your initials at the bottom of the form after completing each day's by the Alr Pollution Control District for a period of at Least two years.. <br /> each box where your inspection revealed no i nspection. Keep copies of work orders and/or equipment pan`receipts <br /> problems,and an"N'in each box where your <br /> Day of ttie Month <br /> 514R - 6:1N10W <br /> (Use TRAFFIC CONES and SAFETY VESTS) T 7 8 QiT2122 289 <br /> TANKAREA ✓ t— <br /> :4- <br /> V cf <br /> is"dept fine PS aCve(s)-present yefJow sticker,no vapor shadows ✓ ✓ <br /> ✓co biers�cfean and drys. Spill container drains-operative and closed, chain attached(if appkable);Vapotus=QaSkets pressn€&tighl:caps not missing,broken or loose ✓ J '� '� '� f <br /> x 11✓ ✓ f <br /> °V/6j-adapters 4i&on riser,dry break poppet is not missingldamaged ✓ ✓ ✓ 1f <br /> w s not missing broken or toosa t, ✓ ✓ ✓ ✓ J J <br /> s;File caps=g$sfrets present and tilt cap <br /> 7, Fill adapters attached tightly to riser,inside cgasketmtmissing ortom <br /> a. Fill tube(coaxial spring-loaded)-present mend,spring Trot broken or sagging FF L --j I I <br /> 9. Coaxial gasket-r`n place,seating vapors <br /> ';a::Filktufie.-(2=Pof+rt}A <br /> serf round ✓ ✓ ✓ ►� t/ (y ljj V I <br /> DISPENSER AREA <br /> 11,Air district decals-feg+bie operating insfruc&ms,tnrrecf compfainf phone# <br /> 1z;.H6ses::fAFIB-aplvrovad,no kinicslEearsfstrts, ZfiD installed cxxractly <br /> 1s-. Biaakamy-s-I C,4RH-approved,m 9quidstein/dust b0dup ✓ J vv ✓ V ✓ <br /> fa:Naxzles-EARB-approvad,has all clamps,swivels work smoottrty, no feaks ✓ ✓ ✓ ✓ ✓ ✓ 'f <br /> i5;_tdozzie hold-open latches-prresentand operating p rmcdy ✓ ^ ✓ <br /> d Ss.:NW�le ibellol m and faceplates-fight on nozzle,no feamAtits,good seal ✓ ✓ ✓ ✓ V V. ✓ J ✓ ✓ <br /> 17-Nozzle spouts=not loose,rrofout-of round,have fahch devices ,/ J <br /> ; <br /> o te: V11 V <br /> >�ler b:vaporwaives�o uapor shadows emrttirxf from nozzle ✓ ' v ✓ ✓ V, <br /> `� 19. Bose Retractor-present with a 10"or less hose loop unless LRD present <br /> w <br /> co INSPECT AT LEAST ONCE PER WEEK <br /> 0 n Draln vapor hose to remove excessive gasoline <br /> N <br /> \ INSPECTOR'S INITIALS: <br /> o <br /> r� <br />