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MonthNear. <br /> ' <br /> Inspection Checklist � Station Name: <br /> Address:Facility PTO#: <br /> Coaxial/2-Point Phase I and Balance Phase II Vapor Recovery Systems <br /> This form was designed for use at stations with inspection turned up equipment defects or other issues requiring further action. related to the noted repairs with the Log. Keep these records <br /> Coaxial or 2-Point Phase I with'Balance Phase 11 Record descriptions of the noted defects and repairs on the Daily-Repair Log: accessible in the Operations&Maintenance Manual for inspection <br /> vapor recovery systems. .Place aCheek mark in Record your initials at the bottom of the form after completing each day4q by the Air Pollution Control District for a period of at least two years. <br /> each box where your inspection revealed no inspection. Keep copies of work orders and/or equipment part receipts <br /> problems,and an"X"in each box where your <br /> Day of the Month <br /> (Use TRAFFIC CONES and SAFETY VESTS) 1 2 3 4 5 6 7 8 9 10.1 l 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 3 <br /> K AREA RL--� <br /> i. Vent•linePVvalve s - resent, ellowsticker,no va or shadows <br /> 00, <br /> 2. S ill containe3. S ill container drains-o erafive and closed,chain attached if a licableI LA <br /> a. Vapor ca s- askets resent&ti ht caps not missing,broken or loose <br /> 5. Vapor adapters,,- ' ' ot missin dame ed <br /> s. Fill caps- askets present and fi ht,caos s not missing broken or loose <br /> 7. Fill adapters-attached ssinq or tom mi , <br /> �- <br /> 8• - aded In <br /> 10. Fill tube- 2-Point resent round <br /> DISPENSER AREA <br /> district decals=le ib/e arating Instructions,correct corn 1alnt hone# <br /> I oses-CARE-a roved,no kinks/tears/slits,LRD installed correctly <br /> l «.- <br /> 13. Breakaways-CARB-approved,no liquid staWdust.bulldu <br /> �e <br /> 14. Nozzles-CARB-a roved,has all clam s,swivels work smooth ,no leaks <br /> A. r/ ✓ r! <br /> t5. Nozzle hold-o an latches resent and cretin conecfl <br /> ✓ <br /> 16. Nozzle bellows and face lates-ti ht on nozzle no tears/sllts, cod seal <br /> ✓, <br /> ». Nozzlespouts-notioose not out01 <br /> -of-round,have latch devices <br /> iw! <br /> 18. Nozzle vapor valves nova orshadows ernfifing from nozzle <br /> ose a ractor- eas resen <br /> INSPECT AT LEAST ONCE PER:WEEK ' <br /> 20. Drain vapor hose to remove eXoGSShVG ga-MlinG00, <br /> INSPECTOR'S 04TW S r <br /> :, <br />