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7onthN111 j E[:F <br /> Inspection <br /> Checklist Station Name: <br /> u� <br /> Address. <br /> 10 Ir. <br /> CoaxiaU 2-Point Phase I and Balance Phase II Vapor Recovery Systems a� I� <br /> This form vias designed for use at statiorrs with inspection turned up equipment defects or other Issues requiring further action. related to the noted repairs wIh the Log. Keep these records <br /> Coaxia€.or 2-Point Phase l With Balance Phase Il Record descriptions cf the noted defects and repairs an the Daily 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 oompleting each day's by the Air Pollution Control District for a period of at least two years.. <br /> each box where your inspection revealed no inspection. Keep copies of work orders andlor equipment partreceipts <br /> pioblems,and an' 'in each boxvrhere your <br /> Day of the Month <br /> (Use TRAFFIC CONES and SAFETY VESTS) <br /> TA NK AREA <br /> �7eriflirrePV�talve(s�-pre"fit,yellow sticker, no Vaporshadaws i✓ v ✓ ✓ ✓ ✓ / <br /> ✓ / ✓ �✓ ✓ J ✓ <br /> z 5p7i I oontainers Mclean and dry <br /> a Spill container drains-aperatrue and dosed,chain attached ff appokabk) <br /> z 4.'V: .ria skefs resent& hf s not missl brtikerr or loose '� ✓ `� V °� ✓ ✓ ✓ <br /> aj3b ps.-ga p t( ,CaA , <br /> ¢ VaObFadapters-tight on riser;dry break poppet is not missing1darvaged <br /> w 1 iE1 raps-jashefspresenf and tigfrt,caps not missOg broken orfoost i✓ J "� ✓ ✓ ✓ ✓ <br /> 7. Fill adapters adaached Ugtttty 10 riser,inside gasket not missing or tom <br /> a. F€Il tube(coaxial spring-loaded)present, rrxmdr goring gatbroken or sagging <br /> 9. Coaxial gasket-in place,sealing vapors <br /> Fill fribe-(2-Norio present,round ✓ f t t/ '✓ Tv ,/ ✓ �/ c/ ✓ f <br /> DISPENSERAREA <br /> it.Air district decals-leglbla operating ktsirucUons,correct complaWphone# <br /> t2:Hases_-CXIRB�apprvved,inn JrtrrksRearsfsiits,!RD insfafledcort�cNy <br /> iv vi'f ✓ ✓ <br /> Sa_;Boeakativays-CAapi MVe`d,no l&lurd sfaiWdusf buildup tl <br /> L/ V/✓ V ✓ V <br /> RPr ✓ ✓ <br /> 14: Nozzles'CARB-rZnpravetJ,has all clamps,swivels work smoothly;ria leaks � if '� '� � ✓ � <br /> I5,:'.N6 zIe-h'b -open latches-present and operating co►reaffy ✓ ✓ <br /> ¢ 1sj-NbSz e' bellows and Templates-fight on nozzle,no tearsfsilts,good seal ✓ ✓ <br /> 17, Nozzle spouts=not loose, not out of-round have;etch devices <br /> ✓ ✓ ✓ ✓ ✓ �/ ✓ J ,� '� <br /> o aa:I7ozz?evapervavesnoi�aporshadows amilyrigfromnozzle ✓ ✓ ✓ t/ <br /> t9. Hose Retractor-present WO a 10"or less hose bop unless LRD present <br /> w <br /> 0C) INSPECT AT LEAST ONCE PER WEEK <br /> 0 20. Drain vapor hose to rennove excessive gaslaVine <br /> c� <br /> \ INSPECTORS INITL5.S: /az <br /> 0 <br />