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SON t�617S1GG"+llUlll7 Checklist: ,�i� � / I �86 9 XAddress4, F <br /> (InCBe�ding Hirt VCS= loo systems) and <br /> Two Pob f�l�i��aae I V alaorr Recoverr ;j <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: Place a check mark (✓) in each box If no problem is found . Mark 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 /> 1 12 P 14 5 6 7 8 j7 0 11 112 113 114 115 116 ji7 118 119 120 121 122 123 24 25 26 27 28 29 0 1 <br /> Tanks area Phase I Vapor Recover <br /> 1 . PV valve– Present No debris. Check for shadows. / ' <br /> 2, S ill container= Clean and dr i v ✓ <br /> 3. Spill container drain valve—Closed not dama ed. V ,/ V <br /> 4. Fill ada ter— Ti ht on riser, swivels ro erJ . ,/ ✓ v „ ,� ✓ , V <br /> 5. Fill ada ter ca Ti ht, masket present, no dama e. / ✓ 77 v v 1/ / / . / VIV <br /> 6. Fill tube—Present, DPW jackscrew assembly tight <br /> 7. Vapor adapter— Tight on riser, poppet present, _ <br /> all ned/not dama ed, swivels prowly. { <br /> B. Vapor ca Tight, gasket pLesent. ,/ v !/ <br /> Dispenser Area Phase Ii vapor Recover <br /> 9. Air District decal—Present w/correct toll free number i �, „ „ <br /> 10 . Hose- EVR-certified, no kinks/slits/tears, LRD <br /> installed correctlyV. v ✓ / i , / / / / ,/ <br /> 11 . Nozzl e—EVR-certified, has all clamps, no leaks, ✓ / / / ` / / / <br /> spout not loose <br /> inspect VST nozzle daily, if a licable <br /> 12. Latch rin - Present, in good repair <br /> 13. Bellows and face late- Present, in good repair / <br /> 14. Hold open latch—Present, In good repair (except for / ✓ ✓ V <br /> VST nozzle without Secondary Release Mechanism / J <br /> 15. Insertion interlock mechanism- operates proper] i ✓ ,� / , , , <br /> 16. Breakaway—Present, EVR-certified, no lealfs 22 me / <br /> 17. Drain vapor hoses of excess gasoline <br /> 18. Retractor—Operates properly, ingood repair / ✓ <br /> Quarterly Inspection : If installed, Check Healy Clean Air Separator tank for proper ball valve position . Date Inspected : <br /> Ball valve A: open/closed Ball valve B : open/closed Ball valve C : open/closed Ball valve D . open/closed <br /> ins ectal"s Initials& <br /> VU <br /> Rev. Aug 2012 <br />