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Month/Year:Inspection Checklist Station Name: <br /> Address: <br /> Coaxial/2-Point Phase I and Balance Phase 11 Vapor Recovery Systems Facility PTO <br /> This form was designed 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 /> Coaxial or 2-Point Phase I with Balance Phase II Record descriptions 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 mark in Record your initials at the bottom of the form after completing each day's by the Air Pollution Control District for a period of at least two years, <br /> each box where your inspection revealed no inspection. Keep copies of work orders and/or equipment part receipts <br /> problems,and an"X"in each box where your <br /> Day of the Month <br /> (Use TRAFFIC CONES and SAFETY VESTS) 1 2 3 4 15 16 17 18 19 11011111211311411511611711811912012,12212312412512612712812930 31 <br /> TANK AREA <br /> t.Vent line PV valve(s)-present,yellow sticker,no vapor shadows ,•X ' " R„ 'a /. M <br /> 2.Spill containers-clean and dryx.' <br /> 3.Spill container drains-operative and closed,chain attached(if applicable) <br /> a.Vapor caps-gaskets present&tight,caps not missing,broken or loose <br /> 5.Vapor adapters-tight on riser,dry break poppet is not missing/damaged ° <br /> s. Fill caps-gaskets present and tight,caps not missing broken or loose XX <br /> 7. Fill adapters attached tightly to riser,inside gasket not missing or tom xxIx <br /> 8. <br /> s. vapors :P <br /> to. Fill tube-(2-Point)present,round _ si� Ix <br /> IN— 4xi, <br /> x <br /> DISPENSER AREA <br /> i t.Air district decals-legible operating instructions,correct complaint phone# <br /> 12.Hoses-CARB-approved,no kinks4ears/slits,LRD installed correctly <br /> 13. Breakaways-GARB-approved,no liquid stain/dust buildup <br /> ta. Nozzles-CARB-approved,has all clamps,swivels work smoothly,no leaks <br /> 15.Nozzle hold-open latches-present and operating correctly <br /> 16,Nozzle bellows and faceplates#fight on nozzle,no tears/slits,good seal XXX <br /> 17. Nozzle spouts-not loose,not out-of-round,have latch devices <br /> 18.Nozzle vapor valves-no vapor shadows emitting from nozzle <br /> t9. t <br /> INSPECT AT LEAST ONCE PER WEEK 5g,� <br /> 120. 1 LIN I <br /> INSPECTOR'S INITIALS: '°` <br /> G <br /> r <br />