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MonthNear. T <br /> C=-_ Inspection Checklist Station Name: <br /> � Address:: <br /> CoaxiaU 2-Point Phase I and Balance Phase 11 Vapor Recovery Systems <br /> This form was designed for use at stations with inspection turned up equipment defects ar other issues ruquiring further adfon. related to the noted repairs with the Log. Keep these records <br /> Ccaxial.or 2-Point Phase 1 with Balance Phase II Record descrtptions of the noted defects and repairs on the Daily Repair Log. accessible in the operations&Maintenance Manual for inspection <br /> vapor recovery systems. Place aCheck m ark in Record your initials at the bottorn of the form after completing each day's by the Ak Pollution Control District for a period of at least two years. <br /> each box where your inspection revea[ed no inspection. Keep copies of WD*orders andlor equipment part receipts <br /> prcblems,and an'X" in each box where your <br /> Day of the Month <br /> (Use TRAFFIC CONES and SAFETY VESTS) 3 4 0 1 7 18 �� <br /> 31 <br /> TANK AREA <br /> ? eirl'iiie l''valve(s) present yellow sikker,no vapor shadows J <br /> 2'. Spill-containers-ciean and dry <br /> 3. Spifl container dfains-operabve and closed,chain attached{ff app6cabde) l <br /> 4; -ps�9askets present&fight caps not missing,broken or loose f f I/ L/ <br /> ,< , <br /> sCaas'-6ghtorlriser, &Ybreakpoppetisrrotmissrng/damaged ✓ <br /> .aFilt;:ceps;gaskets present and Ught caps not missing brafren or loose V <br /> 7. Fill adapters attached tkoly to riser,inside gasket not missing or tom <br /> a Fill tube(coaxial spring-loaded)present round, spring not broken or sagging <br /> s. Coaxial gasket-in place,sealing vapors <br /> > Fillttube-(2-Parnf)present,round U v f <br /> DISPENSER AREA 77-1 <br /> ti.Air district decals-legible operafiny instractons, crorr•ecl=plainf plane# <br /> :1.2:Hosea-URE-approved,no kinksltearslsfils, LRD installed cormc4y ✓ J tf <br /> 19:`:stealssways-6ARB=approved,nolfguids-WrVdustboldup ' V/ l <br /> i4�Ndzzles:-GARB appmvad,has 0 clamps,swivels worfr smoottrfy, no leaks ✓ tf Vr <br /> VV <br /> ie Nozzle-hold-open latches-present and operatng�rreclly =✓ v J '✓ <br /> t6 'Nozzle'bellcivfsrand faceplates-fight on nozzle,no tearslsflts, good seal ✓ <br /> d~ 17, (dazzle spouts riot loose,not out-of-=0n have faith devices <br /> J f I✓ ✓ 1r✓ V <br /> o tai szzla.va*Vatves,10 vapor shadows emitting from narzfe <br /> 19. Hose Retractor-present with a lo'orlesshose loop unless LRDpresent <br /> w <br /> INSP ECT AT LEAST ONCE PER WEEK <br /> CXD <br /> Z=— zo. Drain vapor hose to remove axoessive pasofine <br /> N <br /> INSPECTOR'S INTMLS: <br /> 0 <br /> a <br /> P. <br />