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C,hicaddist o ' a EYR Month , <br /> (�h(�lt ���IC ing HiFt VCS= goo systems) GP d Year: <br /> Site Name: <br /> TWO P©(lll4t! PIT w 9 Vapor pecoverAddress : <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 (r) in each box If no problem is found. Mark with an "Y." 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 2 4 5 6 7 18 19 110 Ill 12 13 14 15 116 117 18 119 20 21 22 3 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 ilk container— C/ean and dr <br /> Spill container drain valve—Closed not lama ed. N <br /> 4. Fill ada ter— Ti ht on riser, swivels ro erl . ✓ f <br /> 5. F11l adapter ca — Ti ht, gasket resent, no damage. ✓ ✓ <br /> 6. Fill tube—Present, DPW ack screw assemblyti ht <br /> 7. Vapor adapter— Tight on riser, poppet present, <br /> alk ned/not dama ed, swivelsproperly, <br /> 8. Vapor ca Ti ht, gasket resent. <br /> Dispenser Area Phase 11 vapor Recover <br /> 9. Air District decal—Present w/correct toll-free number � " <br /> 10 . Hose—EMcertified, no kinks/slits/tears, LRD <br /> installed correct) ✓ f J , J J ,� J J ,� ,/ <br /> 11 . Nozzle—EVR-certified, has all clamps, no leaks, ✓ / ( r , ` <br /> spout not loose (inspect VST nozzle daily, if a licable ✓ ,1 i J J � ,� <br /> 12. Latch ring— Present, incyoodrepair <br /> 13 . Bellows and faceplate—Present, in good re air <br /> 14. Hold open latch—Present, in good repair (except for f f J ✓ f f ✓ / c ✓ ✓ ✓ J ✓ ✓ J <br /> VST nozzle without Secondary Release Mechanism / ✓ f <br /> 15 . Insertion interlock mechanism--operates properly v J <br /> 16. Breakaway— resent, EVR-certified, no leafs / / ✓ <br /> 17. Drain vapor hoses of excess gasoline <br /> 18. Retractor—O erates properly, in good 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 : openlclosed Ball valve D : ppen/closed <br /> Rev. Aug 2012 <br />