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�_ MonthlYear; n!` �G <br /> Inspection Checklist <br /> \ Station tame: <br /> Address: <br /> Coaxial/2-Point Phase.I and Balance Phase 11 Vapor Recovery Systems Facility <br /> This form was des�ned for use at stations with inspection turned up equipment defects or other issues requiring further action. related to the noted repairs with the Log. Keep these records <br /> Coaxlal•or 2-Point Phase I with 13a lance Phase 11 Record descriptions of the noted defects and repairs on the Daily Repair Log. accessible in the Operations&Maintenance Manual for inspection <br /> vapor racovery systerns. Place aCheck mark in Record your initials at the bottom of the Form after completing each day`s til the Air Pollution Control District for a pericd of of le"two years. <br /> each box where your inspection revealed no inspection. Keep copies of work orders andlor equipment part receipts <br /> problems,and an"X"In each box wheae your <br /> Day of the Month <br /> (Use TRAFFIC CONES and SAFETY VESTS) 4 $ 7 t $ Q� 13 14 d �$ 24 2� 27 2$ �$ <br /> TANKAREA f f ✓ J <br /> 1 leuE'line€'Vv ve s)-presen(yetFowstrcker,novaporshadows 11� " f f V '� f <br /> SPaF:con ntainers�cleaand dry L/ `f f Z/ A"/ <br /> J J :✓ <br /> 3. Spill container drains-operative and cJosed, chain aftachea rdappltcabfe) <br /> z 4.Vaporisaps.gaskets present&tight;caps not missing,broken or base i/ rf ✓ Ir� � ✓ � <br /> ¢ 5::V poir-dd"iptats'-iight•on riser,dry break poppet Is not mtsskWdamaged <br /> tf ✓ ✓ ✓ J ✓ vI✓ ✓ �/ ✓ <br /> w 5;FIII"C2p5 g9S1C9tS present and tigrJ'4 caps not Trussing broken or toosa ✓ ✓ t� J J '� ✓ ✓ <br /> 7, FIII adapts attached tightly to riser,inside gasket notmissfng or tom ++ <br /> I- Fill tube(coaxial sprin.94oaded)-FrasenC round,spring stat broken or sagging <br /> 9. Coaxial gasket-irr placer sealing Vaporsji <br /> / <br /> F!.f-tuoe'-(2-Pcint)priasent,round +✓I v � �✓ J � '✓ � � ✓ ✓ f <br /> DISPENSER AREA <br /> 11, Air district decals-Jegrble operaffng fnsln�ctrons,correct complain phone# <br /> 52:Hoses- RB-zppioved,no kJnfcsrlearsfsJ ts, LRD installed correctly v if ✓ ✓ '� ✓ ✓ ✓ J 'I f `� '/ ✓ <br /> is.Bri akaways-CAPB-approved,no liquid sWnfdustbu$dup ✓ ✓ v I '� ✓ ✓ <br /> is Noales-CARS-approved,has all clamps,swrvals work smoothly, no leaks t✓ r/ vj v7- <br /> ✓ l✓ ✓ �f <br /> 15.-Nozzle bold-open Latches present and operating Pcvrectty ✓ f ✓ <br /> ala le b�llo is:and faceplates,tight on nozzle,no tearslWas,good sea! f f Y / 'f V ✓ <br /> 17-Noizte spouts-not loose,not oat-at-mund,have latch devices ✓ tf V, V ✓ f � ✓ Ll °� � fL/ Vi f <br /> �; ✓ d V '✓ <br /> o Ie,_3 rintl�f.uapdrval cin-no vaoorshadows emitting from nozzle If v <br /> ;s. Hose Retractor-present with a 40`orless hose Joop unless LRD present <br /> w <br /> oz� INSPECT AT LEAST©NCE PER WEEK <br /> o zo. Drain vapor hose to remove excessive gasoliT le <br /> c� <br /> \ IIISPECTUM 1NMALS; <br /> 0 <br /> a <br />