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R ^ ac a r� Month : ; eA r2 ) f <br /> Seib kap ar tion Chi eoAdhet Balance EVR /Punas a �U � a <br /> incll� din Girt VCS= 00 s . stains �G��� Year: <br /> �� Site Name : <br /> 1%W® /POtl/171t"' prase 9 Vapor Recovery 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 (s) 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 4 5 6 7 B 9 i0111213141516 _It 718 192021 2223242526272629 0 1 <br /> Tanks area Phase I Vapor Recover <br /> 1 . PV valve— Present No debris. Check for shadows. <br /> 2, S ill container— Clean and dr / l / ,- J / . <br /> 3 . Spill container drain valve—Closed not damac <br /> led, / / / 1 /10/ i i <br /> 4. Fill adapter— Tight on riser, swivels plooperly, 4. ,L 4. 1 Z <br /> 5. Fill adapter no dama,gee /Ti , / <br /> 6. Fill tube—Present, DPW ack screw assembly ti ht _ <br /> 7. Vapor adapter— Tight on riser, poppet present, <br /> aligned/not damaged, swivels ro err . <br /> 6 . Vapor ca Tr ht, asket resent. / / / / /I I / <br /> Dispenser Area Phase II vapor Recover <br /> 9 . Air District decal—Present w/correct toll-free number / _ _ / l / / <br /> 10 . Hose—E' VR-certified, no kinks/silts/tears, LRD <br /> Installed correctly <br /> 11 . Nozzl e—EVR-certified, has all clamps, no leaks, / <br /> s out not loose (Inspect VST nozzle dail , if a licabie <br /> 12. Latch ring--Present, Ingood repair A dJ 7177 / 2J / ao / <br /> 13. Mims and face late– Present in good re air i / ✓ ' <br /> 14, Hold open latch—Present, In good repair (except for /VST nozzle without Seconda Release Mechanism / / / / i J / 1 �16. Insertion interlock mechanism-- -o erates ro erly / i i J j / / <br /> 16. Breakaway—Present, EVR-certlfied, no leaks t / l / 7 / j <br /> 17. Drain vapor hoses of excess gasollne <br /> 18. Retractor—Operates pLoparly,. In good repair / / / J i <br /> Quarterly Inspection , If installed, Check Healy Clean Air Separator tank for proper ball valve position. Date Inspected : <br /> ((B�a�l) valve Al open/closed Balt valve S : open/closed Ball valve C : upon/closed Bal ! valve D : open/closed <br /> rl�i (�6:dctBG'' �G )iA$ia11 _ I _ i J�' I �E_1_l_(rL �v1 ►,� I�-!�1 <br /> Rev. Au9 2012 <br />