Laserfiche WebLink
Self Inspection Chec940s �a`„ �Q� fr� �� t�� Month: <br /> (including Hirt VCS-100 systems) and <br /> Year: <br /> Site Name: (� <br /> Twp P®lnt Phase g Vapor Recovery y Aadress <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")"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 slde;of this form for more information. <br /> Day of the Month <br /> 1 , 2P P6 0 111 P2 PS 114,115 PS ? 18 9 0 P7 <br /> Tanks area Phase,I Vapor Recovery) <br /> PW valve--Present. No debris. Check for shadows. " <br /> . Sill container—Clean and ft <br /> Spill container drain valve--Closed not dam ed <br /> Fill ada ler-T1 ht on riser,swivelsro erl . <br /> . <br /> Fill,adapter ea Tl ht, asket resent, no damage, r , <br /> . Fit Ctube—Present DPW'ack screw assemb/ ti ht <br /> Vapor adapter—Tight on riser,poppet present, <br /> red/not slam ed swivels Oroperk, <br /> 6. V or ca Ti ht aslcef resent: <br /> Dls enser Area Phase Ii or,Recove <br /> 9. Alr,fUstrict:dead--Present wlcorrect toll-free number' <br /> t 0. H -E'VR-certlfled, neo kinks/slits/tears, LRD <br /> nstallrrect/ /A/A�NN/1 17 <br /> 11. Nozzle--�EVR-certified, has al!clamps, no leaks, <br /> s out not loose ins ect VST nozzle Mfg. if a licable <br /> 1 . Latch ring: Present, in good re"air ,Y <br /> 13 Bellows and face °late--Present;in ood re air <br /> 4 Hold open latch---Present,fn good repair(except for <br /> VST nozzle without condary Release Mechanism r <br /> 15. insertion interlock mechanlsM--- erates r erl <br /> � . <br /> 16.Breakawa ---Present EVR-cert/fled, no leaks ,, <br /> 17. Drain va or hosefsl of excess gasoline <br /> f 8. Retractor—O erates pLoperly, in Ood repair <br /> Quarterly inspection: lfinstalled,Check Healy Clean Air Separator tank for proper ball valve position. Date inspected: <br /> Ball valve A:open/closed Bali valve B: opentciosedBali valve G:Doan/closed Bal!valve D:open/closed <br /> fns �c�®re's�ni�iad�: <br /> Rev.Aug 2012 <br />