Laserfiche WebLink
Northam Raplen Of&;s [ ] Central Reglan Office [ ) southern Region Office <br /> 1320 l9amsn Ave„3ufta 130 1990 E GWvvburg Avenue 2700 M St.,SUNG 273 <br /> Modeata,CA 953WQ321 Freano,CA 93728.4244 Baksraflaid,CA 93301.2370 <br /> (2D9)357-04DO (559)29OMW (MI)320-6104 <br /> Phase I &.Phase 11 Gasoline Vapor Recovery Inspection Form <br /> Stsdon Name: 07( GAG PTO: /V VI 8"17 /- <br /> Location; City: Z.Dd,- Phone a 3 i <br /> Melling Address, a, �- 3 O G City: t,v t: State: l i�l zip; .?• r <br /> Contact: 1)t e),-? S �'Ca t!rGt v1lt Title r' l f�.T frac cC �,i'LJ'�, /�'li< <br /> Inspection Typo: [ jCornplaint [ 111" ( 12"4 Semi Annual ( ]I* [ j2r4 Follow-up To: <br /> Nuzzles InspecW(Model and Dispenser Number) <br /> Phase I System Type: "2-Point ( j Coaxial Phase I1 System Type: ipy"/fvy�C <br /> Tank Number 1 3 4 Nozzle Number <br /> Produd Type Product Type <br /> Location Nozda Type <br /> 1. BrokenffAlssing Vapor Cap 1. Nozzle <br /> 2. Broken/Missing Fill Ctip 2. Insertion Interlock <br /> 3. Vapor Cap Not Seated 3. Check Valve <br /> 4. FIN Cop Not Seated 4. (race Plate/Seal <br /> 5. Vapor Cap Gasket Missing 5, Ring/Rivet <br /> 6. Fill Cap Gasket Missing 9. Bellows <br /> 7. Vapor Adapter Not Tight 7. Bellows ClampJWlre <br /> 8. Fill Adapter Nat Tight 8. Swivel(s) <br /> Dry Break Gasket Deteriorated 9. Hold Open Latch <br /> 10, Gasket Between Adapter And 10. Bose <br /> Fill Tube Missing/Not Seated 11. Hose Configuration <br /> 11. Coaxial Fill Tube Spring 12. Liquid Removal Sys, <br /> Defective 13. GPM <br /> 12. Pressure Vacuum Relief Valve J Incinerator function [ }System Pressure [ ]SI ns Posted (X■Deficiency) <br /> 13. Other. KEY FOR DEFICIENCIES <br /> Tank Depth AD RAdjustnwnt, B■Broken. F-Rat, FR=Frayed, 014inked, L-Long, L0-Loose, <br /> Fill Tube Length Ming. MA-Mlsslignsd, NCGNat Cart ed, Short, 70 Tom <br /> Difference(W or less) inspection Result <br /> Phase I Report Check marks Indicate component Phage 11 Report 7=repair within 7 days, T=Togged out of order until <br /> deficiencies repaired, U'Taggabie violation corrected during inspection <br /> Comments: r'a'c y ;V-5Ckt-1 C].D �at.�1c{ iba.,t! r�Y'Z-L'- l "Olvs-'C ,�,f-vyj r11P/ol .9 avis Q�cfc <br /> Il , <br /> 1/�-��+° tit� -f�t,.,C Uc�yr�; '.tit �USf c f �(� CJC�CL��•.�- u-rt' ,..�s�rC.��.f��r' c-,. ��r. c�r .•r <br /> I T <br /> Inspector: << K� L'1Xs Date: 4/f/0r/4913 Raceived`By_ Y <br /> Nhsn repairs are completes calf ( } <br /> Warning: stems checked above In th*Phase I portion of the inrpaction form and items coded with a"T"or"U"in the Phase i1 <br /> Inspection results category aro In Violwtion of San Joaquin Valley Unified Air Pollution Control District ruts(*). The <br /> California Wealth A Safety code spscMiss penalties for each clay of violation. <br /> Note: CA H*aith A Surety code 8actlon 41960.7(s)requires that the above:listed 7-day deficiencies be repaired vNthin 7 days. <br /> I■vOr MOG Fallur+e to do so will result In legal action, <br /> z 'd 3SW Je2 :01 E0 01 .add <br />