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self Inspection Checlrilist. ��?, ' VR Mai se 8 Month: <br /> (including Hirt VCS-I00 8 ate/lr a d Year: <br /> �, anSite Name: <br /> Two Pint Phase I Vapor Recovery Address: <br /> Inspection frequency, Five(5)days per week,unless throughput Is less than 25,000 gallons per month then weekly inspections are required.' <br /> Instructions: Placa a check mark(v)in each box if no problem is found. Mark with an"X"any box if a problem Is found.,Record arty 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 tnfonna#ion. <br /> Day of the Month <br /> i 0 11 pg 113,li4 11# 16 17 118 P9 0' 1 2 7 P&rp1 <br /> Tanks area Phase 1 Vapor Recover <br /> . PV valve--Present IVo debris. Check for shadows. <br /> 80111 container-=C1ean and.dry <br /> l r f <br /> . S iii container drain valve--Closed not dam ed. / f ,, <br /> 51V Zl'/l <br /> . Fill,ad ` ter-77 ht on riser swivels ro er! . l f <br /> 5. Fill oda ter ca TI ht asket resent, no lama e. <br /> S. Fill tube—Present OPW ackscrew assembl ti ht <br /> .;Vapor adapter:Tight on riser,poppet present, <br /> all ned/not dam ed swivels` ro erJ . <br /> 0. Vapor cap, F ht asket resent' l l j -" 41 <br /> Dis' enser Area Phase ll vapor Recovery) <br /> 9. Air District d ecal--Present w/correct fall-free number // <br /> 10. Hose--EVR-ioertl€led,no kinks/slltsAears, LRD <br /> Installed corracti <br /> 11. Nozzle--EVR-certlfled,has all clamps, nd leaks, <br /> out not loose ins ect VST nozzle dal! if 299mmtLe2 A/ / <br /> 12. Latch:rin --Present 7n ood re .alr <br /> 3. Bellows and-face (ate=Present,in ood re air l- e-- <br /> 1,4. / l <br /> !Hold opera latch--Present,;In good repair(except for <br /> VST nozzle without Second Release Mechanlsm l l10, ITf l <br /> 15.'Insertion interiock mechanist»---o erates Oroped �- <br /> 16. Breakawa �--Present, EVR'-certJfied no leaks / J <br /> 17. Drain v or hoses of excess asoline <br /> 18. 'Retractor—O rates pagerl ,Ingood repair <br /> Quarterly inspection: Iffnstalled,Check Healy Clean Air Separator tank forproper bail valve position. Date Inspected: <br /> Ball valve A:openlclosed Ball valve B:pp—en/closed Bali valve C, open(cfosed Ball valve t?:open/closed <br /> 9ns eddy-.4 Initials <br /> Rev.Aug 2w2 <br />