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i <br /> s�tly, r�ap6r�i� 090 Ch/(s?�,Adj6o toil agkomcce E VR �Phaserrz (99 WON <br /> Month : �-t,,�D <br /> r>���bd§ng �'OF9 VC�p 11 �0 SYS, 68MS) v, c�7 Year: � <br /> Site Name: <br /> Two iPohni Ir Pham a Vapor §7 a verf ,/ Address : <br /> inspection frequencyt 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 (v) 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 /> Depy of the Month <br /> 1 2 3 4 5 6 7 18 9 ! 01112131415161718192021 223242526 272629 031 <br /> Tanks area Phase I Vapor Recover <br /> . PV valve– Present: No debris. Check for shadows. <br /> 2. S iii container -- Clean and di• l J <br /> 8. S III container drain valve—Closed not lama ed <br /> 4. Fill ada ter— Ti hf on riser, swivels ro erl . <br /> 5. FIII ada ter ca Ti, ht, gasket present, no damage. l l l l l — — — <br /> 6. Fill tube—Present, OPW ack screw assemblY ti ht _ — <br /> 7, Vapor adapter— Tight on riser, poppet present, <br /> all ned/not damaged, swivels ro erl . <br /> 8. Va or ca Ti ht; gasket present. <br /> Dispenser Area Phase II vapor Recover go <br /> S. Air District decal—Present w/correct toll-free number � L <br /> 10 . !-lose—EVR-certified, no kinks/slits/tears, LR© — <br /> installed correct/ l <br /> 11 . Nozzl e—E•VR-certified, has all clamps, no leaks, — — <br /> s out not loose ins ect VST nozzle daily, if a /icable ( � l l <br /> 12, Latch ring--Present, ingood repair Z e <br /> 13. Bellows and faceplate—Present, in good re air <br /> 14. Hold open latch—Present, In good repair (e)tcept for - <br /> VST nozzle without Secondary Release Mechanism)C l l <br /> 115 . Insertion interlock mechanism--operates ro er1V <br /> 16 . Breakawa —Present, EVR-certified, no leaks �- — <br /> 17. Drain va of hoses of excess gasoline <br /> 1 Be Retractor—Operates propqrl , in goad repay <br /> Quarterly Inspection : Ifinstalled, Check Healy Clean Air Separator tank for proper ball valve position . Date Inspected: <br /> t3a11 valve A : open/closed Rall valve B : open/closed Ball valve on, open/closed Ball valve D : open/closed <br /> Rev Aug 2012 <br />