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I <br /> SON gf(t SpectlRl an C?hieollUsti alegf(1 c EVR fta so ilk Month : <br /> Incl din 6�iirr� VC8s= WOO s i st anva� and Year: <br /> � � Site Name : <br /> Two POW Phase § Vapor Roca ver'y 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 (✓) 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 /> Day of the Month <br /> 1 2 P 4 5 6 7 B 9 10 11 112 -113—"1415 16 17 118- 119 20 21 22 23 24 25 26 27 26 9 0 1 <br /> Tanks area Phase I Vapor Recovery <br /> 1 . PV valve--Present. No debris. Check for shadows. <br /> 2, S 111 container— Clean and dr ,l �/ V J J <br /> 3. S III container drain valve—Closed not dams. ed J v <br /> 4. Fill ala ter— Ti ht on riser, swivels ro erl , u ✓ '� J ✓ ✓ J <br /> 5. Fill ada ter ca Ti ht, asket resent, no dama e. <br /> 6 . Fill tube—Present, DPW ack screw assembl ti ht <br /> 7. Vapor adapter— T/ghf on rJser, poppet present, — - - <br /> all ned/not dama ed swivels ro er! . v <br /> Be Vapor ca Tight, gasket resent, v v <br /> Dispenser Area Phase Il vapor Recover <br /> 9. Air District decal—Present w/correct toll-free number _ t% . VIV 161 \/ IV IV <br /> 10 . Hose—EVR-certified, no kinks/s/lts/tears, LRD <br /> installed correct) ^� L/ ✓ ✓ c ./ ✓ ✓ " f ✓ ✓ / ✓ <br /> 11 . Nozzle—EVR-certified, has all clamps, no leaks, l / , / / -7 J ✓ J f <br /> s out not loose (inspect VST nozzle daft , If a licable ✓ v J V d V <br /> 12. Latch rin --Present, in good re airMe 7, ;/ , ✓ J , <br /> 13 . Bellows and faceplate—Present, in goodrepah ./ ( J <br /> 14. Hold open latch—Present, In good repair (except for ( <br /> 71 <br /> VST nozzle without Seconda Release Mechanism 'J v! V <br /> 15. Insertion interlock mechanism--o erates ro eriy 4 1 ✓ ✓ i ri <br /> 16. Breakaway—Present, EVR-certified, no leaks / 7 1 <br /> 17. Drain vapor hoses of excess gasoline F <br /> jF — _ <br /> 18. Retractor—Operates properly, In good re air IV I FNI7 7174 <br /> Quarterly Inspection : If installed, Check I-lealy Clean Air Separator tank for proper ball valve position . Date inspected : <br /> 13a11 valve A : openlclosed Ball valve B : open/closed Ball valve C : open/closed Ball valve D : open/closed <br /> Rev. Aug 2012 <br />