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C <br /> IvlantS'I+Year. _?A,S'�j";'�•` <br /> Ini p e wt i w n' Checklist <br /> Station Name: <br /> 1`J {v` (�+} Address: <br /> Ccaxjal/2-Point Phase I and Balance Phase 11 Vapor Recovery Systems Facility <br /> This farm was designed for use at stalbns with inspection€mined up equipment defects or other issues requiring further actJon. related to the noted repairs with the Log. Keep these records <br /> Coaxial.or 2-Paint Phase I with Balance Phase 11 Record descriptions of the noted defects a nd repairs on the CaPy Repair Log. accessible in the aperalicns&Maintenance Manua I for inspection <br /> vapor recovery systems. Place aCheck mark in Record your initials at the bottom of The form atter completing each day's by the Air Pollution Control District For a period of at least hvo years. <br /> each box where your inspection revealed no inspection. Keep copies of worts orders andlor equipment part receipts <br /> problems,and an"X" in eaa box where your <br /> Day of the Month <br /> {Use TRAFFIC CONES and SAFETY VESTS} 3 4 10 11 17 18 24 25 29 34 31 <br /> TANK AREA 6/7 <br /> xF- e�it'liii V valve{s)-present)elkw sfkkar;no vapor shadows J ro� .1 1/1 J <br /> 21'SPUcoremlrieis•-clean and dry '� ✓ , `` <br /> a Spill container drains-operative and dosed,chain aftactwor(rt applicable)) / <br /> 4.Vapor,caps�-gaskets.pin sent&ligh( caps not missing,broken El or ✓ f �! <br /> ✓ J <br /> ¢ s;'lrapp�adapters-Gghtonriser,dry break pcppetlsrTotrrrfssiag/damaged 1✓ ✓ ! <br /> w 8:F111. ep <br /> cs,gaskets'pmserrt and tight,caps not m ssing broken or loose / J ✓ <br /> ;. FiIE adapters aftaciied tlghiJy to user,insiae gasket not mfssrng orfom ✓ c� t� +f L/ <br /> a_ FII I tube(coaxial spring-loaded)present round,spring Tat brafren orsaggrng <br /> S. coaxial gasket-in place,seaJrng vapors / <br /> to: Fill tube'L-{2 f'o o preser7f,round ✓ 1 V1 V v <br /> DISPENSER AREA <br /> 11, Air district decals-fegrbie operating insfructlorTs cursor WmpiaW irhorre# <br /> .i :-Hoses-CARD-approved,no kirftL-ars/sfrts,LRD installed cnrrecfly ✓ ✓ ✓ `f J <br /> iz.B eakaviayis-CARa-approved,no Ouid statnfdust beHdup i/ <br /> r4:-N - les'.GARB-approved,has a#clamps,swivels work smoothly, no fzaks � � 4� � L f <br /> is;Nfo¢ile holrlispen latches-present and operaU(ig porrectty V V V V1 VI J <br /> is. Nozzle belloti+rs and faceplates dight an rrozzfe,no tears/sfits,goad seal L/ <br /> �* 17. Nciae spouts-rnvt loose,not oLit-of-round,have latch devices <br /> 0 1a.:Nczzle•:vaporvalves-no vaporshadows emitUng from norzfe ✓✓ ✓ <br /> w ie. Hose Retractor-present with a I O'or iesshose loop unfess LRD present <br /> INSPECT AT LEAST ONCE PER WEEK <br /> 0 2n. DTaln vapor hose to remove excessive asoline <br /> N <br /> \ 1NSPEC;TOWS INrrIALS: <br /> 0 <br />