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r 1 c <br /> SON OU��� . � ct i <br /> On C evckftt�"ii* Gull nce VGA Ph gas H Month , L1� <br /> Q'o�it��UJ1C ding ,ffln ►VCC3m ` 00 s ►yst�ams) and Year: <br /> Site Name : <br /> Two Pohl tPhase § Vapory RPuecovGrty Address : <br /> hispection freguencyt 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 (,/) In each box If no problem is found. Mark with an 'W' 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 B 9 10 11 12 13 14 16 1 B 17 18 19 20 21 22 23 24 25 26 27 26 29 0 1 <br /> Tanks area Phase I Vapor Recover <br /> 1 . PV <br /> valve--Present: No debris. Check for shadows. ✓ ;: ' <br /> 2. ll container— Clean and dr ✓ / ✓ ✓ <br /> 3. Sill container drain valve—Closed not dama ed. v <br /> 4. Fill ada ter— Ti ht on riser, swivels ro er! . <br /> 5. Fill ada ter ca Ti ht, asket resent, no lama e. <br /> 6. Fill tube—Present, OPW ack screw assembl ti ht _ <br /> 7, Vapor adapter— Tight on riser, poppet present, -- — <br /> ali ned/not dama ed swivelsro erl . <br /> 8 . Va or ca Ti ht, ashefi resent. J / <br /> Dis enser Area Phase 11 vapor Recover <br /> 9 . Alr District decal—Present w/correct toll-free number <br /> 10 . Hose—EVR-certified, no kinks/slits/tears, LRD - - <br /> installed correct! f ✓ �/ l .! l <br /> 11 . Nozzl e—EVR-certified, has all clamps, no leaks, 7 /spout not loose Inspect VST nozzle daily, if aPplicable ✓ / ✓ •✓ / ,� ✓ <br /> 12. Latch rin - Present, in good repair ✓ ; ✓ / <br /> 13. Bellows and faceplate—Present, in qood repair ✓ ✓ V <br /> 14. Hold open latch- Present, In good repair (except for ✓ f J / J / J f ✓ , , 1f ✓ J f J <br /> VST nozzle without SecondaryRelease Mechanism �l 1 �. <br /> 15 , insertion interlock mechanism -p erates ro eriv <br /> 16. Breakawa --Present, EVR-certlfled, no lealts v ✓ 7 J / / NONE <br /> if / IV <br /> 17. brain va or hoses of excess gasoline / <br /> 18. Retractor—O erates ro erl , in good repair J 7` / 41 <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 8a11 valve D : op,en/closed <br /> Rev. Aug 2012 <br />