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Sam r ed©r C�G�c c �,��© a ��u�� EYR phi - � `ff Month . <br /> G �� Year: <br /> (including Hirt VCS= 100 s.Dyatama) and Site Name : � � <br /> Two j' m11117t tt P1 Bee § Vapor RecovaFy 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 /> instructions : Place a check mark (e) 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 /> Da of the Month <br /> i 2 4 5 6 7 8 9 i0 11 12 13 a 15 16 i7 18 19 20 21 22 23 r4 25 26 2711 29 P0 1 <br /> Tanks area Phase I Vapor Recover <br /> 1 . oll <br /> PV valve—Present No debris. Check for shadows. ;` / / / <br /> 2 S ill container-- Clean and dr ' <br /> 3 . S ill container drain valve—Closed not damaged Fill ada ter— Ti ht on riser, swivels ro erl . , <br /> 5. Fill ada ter ca — Ti ht, gasicet present, no damage. doo <br /> Be Fill tube—Present, DPW ack screw assembl ti ht <br /> 7. Vapor adapter— Tight on riser, poppet present, <br /> ali ned/not dama ed, swivels ro er! . dill <br /> 8 . Vapor capmmmmmm Eight, asket present, <br /> Dispenser Area Phase 11 vapor Recover <br /> 9. Air District decal—Present w/correct toll-free number <br /> 10 . Hose—EVR-certified, no kinks/slits/tears, LRD <br /> Installed correctly <br /> 11 . Nozzle--EVR-certified, has all clamps, no leaks, rr 41 <br /> s out not loose (inspect VST nozzle daily, if a / T1 d/ / / / <br /> licable <br /> 12 . Latch ring—Present, in good re air <br /> Oil <br /> 13 . Bellows and faceplate—Present, ingood re air All <br /> 14. Hold open latch—Present, In good repair (except for <br /> VST nozzle without Secondary Release Mechanism) M / 0 / <br /> 15. Insertion interlock mechanism--operates proper] Old 000do/Y tool 000o/ Z <br /> 16 . Breakawa —Present, EVR-certified, no leaks lid z a <br /> 17. Drain vapor hoses of excess gasolinef. . 4 .q rrr <br /> 18 . Retractor—O eratesro erl , in oodre 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 B : open/closed Ball valve C: open/closed Ball valve D : men/closed <br /> _ In cec we"s Iniisials . <br /> Rev. Aug 2012 <br />