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4469 South Escalon Bellota Road PR0540158 <br /> May 14, 2019 Program: APSA <br /> PHOTO 3: Dail ins ection form being used instead of the monthl SP001 inspection form in the SPCCplan. <br /> Inspection Checklist MondWear <br /> Coaxial/2-Point Phase I and Balance Phase II Vapor Recovery Station Name <br /> ry Systems Address: <br /> ,.i <br /> t' This form was designed for use at stations with inspection turned u m' <br /> Coaxial or 2-Point Phase I with Balance Phase If p equipment defects or other issues requiring <br /> Record descriptions t lee noted defects and repairs on the Daily Repair L <br /> vapor recovery systems. Place aCheek mark in further action. related to the noted repairs with the L <br /> Record your initials at the bottom of the fo 09 Keep these <br /> each box where your inspection revealed no inspection.Kee �after completing each day's � bccessible in the pp�at�„s 8 Maintenance Manual <br /> ins p copies of work orders and/orequipment part receipts oft$ <br /> problems,and an"X"in each box where yourY the Air Pollution Control Distract for <br /> ( a period of at k <br /> (Use TRAFFIC CONES and SAFETY VESTS) 1 2 3 4 5 6 7 Day of the Month <br /> 8 <br /> TANK AREA 9 loll 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 <br /> R` ' + ' i.Vent line PV valve(s)-present,yellow sticker,no vapor shadows <br /> !/1■ ■ 2.Spill containers-clean and dry V V 1/ V/y <br /> 3.Spill container drains-operative and closed,chain attached(if applicable) ` V <br /> Z4Vapor caps-gaskets present 6 tight,caps not missing,broken or loose ✓ <br /> s Vapor adapters-fight on riser,d break o V V / <br /> dry Poppet is not missing/damaged � / <br /> _J s Fill caps-gaskets present and tight,caps not missing broken or loose V <br /> f, V V <br /> Qr Fill adapters attached tightly to riser,inside gasket not missing or tom / <br /> E.Fill tube(coaxial spring-loaded)present.round,spring notbroken or sagging \ ✓t/ <br /> Z9 Coaxial gasket-in place,sealing vapors <br /> 10.Fill tube-(2-Point)present,roundLU \ y <br /> DISPENSER AREA V V (! V <br /> : 11.Air district decals-legible operating instructions,correct complaint phone# <br /> Z ✓ <br /> 12.Hoses-CARB-approved, ve ki s/tears/lits,LRD installed correctly <br /> 0 13 Breakaways-CARB-approved,no liquid stain/dust buildup <br /> 14.Nozzles-CARB-approved,has afl clamps,swivels work smoothly,no leaks <br /> 15.Nozzle hold-open latches-present and operating correctly <br /> V v <br /> 1s Nozzle bellows and faceplates light on nozzle,no tears/s/its,good seal <br /> Z V 4'✓ ✓ <br /> n.Nozzle spouts-not loose,not out-of-round,have latch devices ✓ � <br /> JAf e Nozzle vapor valves novapor shadows emitting from nozzle ✓ <br /> 1g Hose Retractor-present with a 10"or less hose loop unless LRD present <br /> 20 INSPECT AT LE ST ONCE PER WEEK <br /> 20.Drain va or emove excessive asoline \ V ! V <br /> SPECTOR'S INITIALS: �1 J <br /> ti <br /> �t <br /> Lydia Baker, REHS Page 3 of 3 <br />