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EYR Phase 00 Month : �►'Yl Y� <br /> (including Him VC 3m 100 s yster s) and Year: � <br /> Site Name : <br /> Two Poona Flues I Vapor pTec© v(prr�y 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 /> Instructionsc 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 repalr log. Keep these <br /> records In your Operations and Maintenance manual for five (5) years. See the reverse slde of this form for more Information. <br /> D2V of the Month <br /> 1 12 P r 5 6 7 8 9 10 11 12 13 14 15 16 17 18 i9 20 1 22 23 24 25 6 27 28 9 0 1 <br /> Tanks area Phase I Vapor Recover <br /> 1 . PV valve--Present. No debris. Check for shadows. F <br /> 2. Spill container- Clean and dr J <br /> 3. S ill container drain valve-5/os ed not dama ed. <br /> 4. Fill ada ter— Ti ht on riser, swivels ro erl . <br /> 5. Fill adapter ca Ti ht, asl�et present, no dama e. <br /> B. Fill tube—Present, DPW ack screw assembly ti ht <br /> l7a Vapor adapter— Tight on riser, poppet present, — <br /> all ned/not dama ed, swivels properliv. "F} <br /> 8. Vapor ca Ti ht, ashet nresent. <br /> Dispenser Area Phase II Vapor Recover <br /> Wr <br /> 9, Air District decal—Present w/correct toll-free number <br /> 10 . Hose—EVRomcertifled, no kinks/slits/tears, LRD <br /> installed correct/ f / : ,� / ✓ J <br /> 11 . Nozzle—EVR-certified, has all clamps, no leal(s, ✓ <br /> s out not loose ins ect VST nozzle dail , if a licable �t <br /> 12. Latch rin --Present, in ood re air <br /> 13 . Bellows and faceplate—Present, in good repair ti . J <br /> 14 . Hold open latch—Present, In good repair (except for ✓ / / ! J J ✓ J ✓ ) <br /> VST nozzle without Seconda Release Mechanism) d J J ✓ l / / <br /> 15. Insertion interlock mechanism- o eratesro erly ,/ V <br /> 18. Breakawa —Present, EVR-certified, no leaks f <br /> 17. Drain va or hose s of excess asoline <br /> 18. Retractor—G erates ro erl , in ood re air ✓ / / <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 8 : oven/closed Bali valve C : open/closed Ball valve D: open/closed <br /> Inspocipi's Initials, 1771 F I <br /> Rev. Aug 2012 <br />