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S <br /> 0o IL Monthffear, '0-00-, ? <br /> o <br /> Inspection' Checklist Addfssa Address: <br /> Coaxiall 2-Point Phase 1 and Balance Phase H Vapor Recovery Systems Facility <br /> This form was designed for use at stations with inspection turned up equiptnent defects or other issues requiring further action. related to the noted repairs with the Log. Keep these records <br /> Coaxiai•or 2-Point Phase l with Balance Phase Il Record descriptions of the noted defects and repairs on the Dally Repair Log. accessible in the 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 Air Pollution Control District for a period of at least two years.. <br /> each box where your inspection Tavealed no inspection. Keep copies of work orders ancUor equipment part receipts <br /> problems,and an'W'in each box where you r <br /> Day of the Month <br /> (Use TRAFFIC CONES Ind SAFETY VESTS) F900 415 011811,3 21pola 23 12fi 34 <br /> TANK AREA ! if <br /> Laejif�iria PV:Yalve(s)present yeffowsticker no vaaorshadows i/ <br /> ✓ J � ✓ ✓ <br /> xispi0-6ontainers=clean and dry <br /> f t, ✓ �/ J J <br /> i <br /> s. Spill container d rales-qDeraffve and closed chain attached(if OPOSSWO J <br /> 4.Vapw raps-gasketspfesent&tight,caps notmissing,broken orloose J J f ✓ ✓ I/ <br /> s.`V6p6K adoters-tight on riser,dry break poppet is not missingldarrmaged ✓ t,7 ✓ J v f <br /> w -s:Fill:cape-gaskats present and hghir caps not rrtiss0g,broken or loose ✓ v <br /> 7. Fill adapters aflactred Ughtty fa riser,inside gasket not missing or tem <br /> e. Fill tube(coaxial spring-loaded)present, rnund,spring qot broken or sagging <br /> s. Coaxial gasket in puce,seagng vapors <br /> tu:"fill abbe-(2-,Pain present,round / ✓ ✓ ✓ <br /> ❑iSPENSERAREA <br /> it.Air district decals-legibte operaUng irTstnrcUons,correct cornplarntphone# <br /> 2.1-L4es:-iC4R&appraved,no kinksiteareslits, LRD installed correctly ✓ / '✓ V J V ' ✓ <br /> A V <br /> aa::Bre—46*a -GARB approved,no ffqurd sfairVdust buildup V 77 7 I � �f <br /> t4;tdoazles=G}IRB-approved,has aft clamps,swivels xrofls smoQfhfy,no teaks ✓ V v <br /> is.Nezzk h -open latches-present and operati V corractty I/ ✓ L '� ✓ 'f J ✓ f V, ✓ <br /> 17 <br /> nid <br /> ¢ 16;Nco,Ae bell-ovitand lacaplates-tight on nozzle,no tearsrslits,good seal VV <br /> ✓ ✓ t/ <br /> 17..Nozzle$poufs=nor those,nofout of-round,have Latch devices ✓ ✓ <br /> CT) qa;1467mie=uapor'valves-i o vaporshadrnvs em��ting fr>xn nozzle <br /> p <br /> 19, Hose Retractor-presentw&a 10"or less hose bOP unless LRD present <br /> w <br /> INSPECT AT FAST ONCE PER WEEK <br /> 0 2o. Drain vapor hDse to remove excessive gasaiine <br /> N <br /> \ INSPECTOR'S 1411 ALS: <br /> 0 <br /> a <br /> 6 <br />