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Self Inspection Checklist. <br /> �� C�i� ����� !14 Month: <br /> � and <br /> (including Hirt VCS-100 system-9) Year; <br /> ,� Site Name: <br /> Two Point Phase I Vapor Recovery Address: <br /> inspection frequency; Five(5)days per wreak,unless throughput is less than 25,000 gallons per month then weekly Inspections are required. <br /> Instructions: Place a check mark(✓j in each box If no problem Is found. Marti with an"X"any box if a problem is found. Record any problems in your repair log. Keep these <br /> records In your Operations and Maintenance manual for five(5)years, See the reverse side of this form for more Information. <br /> Day of the Month <br /> 1d Ill P2 113,14 116 18 P7 IM P9 PP P1 P2 P 4 PS P6,P1 8 9 0 1 <br /> Tanks area Phase 1 Yapor Recove <br /> . PV valve--Present No debris. Check for shadows. l / /, l <br /> Spill contalner--Clean and dr kel / / <br /> . <br /> Spill container drain valve-=-Closed not lama ad AAJ i17 <br /> . Fill ad ter r h#on riser,swivelsro er! , l <br /> . Fill ada ter c TI"ht,gqsketpLeseqt, no dams e. <br /> S. Fill tube—Presenf OPW ack screw assembly fight <br /> 7. Vapor adapter—Tight on riser,poppet present, <br /> a/i ned/nal dam" ed swivels ro eri . <br /> U or c Ti ht ggqlet `resent. 7-1 Zr <br /> Dls enser':Area Phase ll ua or Recovery),,- <br /> 9. <br /> Air District decal--Present w/correct toll fres number ' <br /> 14. Hose--EVR-cert fled,no kinks/slitsltears, LRD <br /> Installed corrects <br /> 11. Nozzle=-EVR-certified, has alt claneps,,no/sales, <br /> out not loose CinspectUST nozzle daily, if a licabie f <br /> 12. Latch rin ..-.Present,in good re a!r A A,f <br /> 13.;Bellows and face late--Present, in good re air % l <br /> 14. Hold open latch--Present,In'good repair(except for <br /> VST nozzle without Secondaty Release Mechanism el, <br /> 5. Insertion interlock mechanism—o states properly f ,� �r <br /> 16. Breakaway—Present, EVR cerflfied,'no leaks / , / ! <br /> 7. Drain vapor hoses of excess gasoline <br /> 18. Retractor:O rates ro ed , !n' ood repair l <br /> Quarterly Inspection: /f installed, Check Healy Clean Air Separator tank for proper mall valve position. Date Inspected: <br /> Ball vaive A:open/closed Ball valve B: open/closed Ball valve C:apenlclosed Ball valve D.Open/closed <br /> Ins eelor's Ihitiala: <br /> Rev.Aug 2012 <br />