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Month/Year t_ <br /> E7Z� <br /> a Station <br /> Inspection t Address:. (,*2- <br /> Fa I <br /> Faality PTO# <br /> CoaxiaV 2-Point Phase I and Balance Phase 11 Vapor Recovery Systems <br /> ant d®feots or other issues requiring further action. related fo the noted with the Log..Keep tt>ese records <br /> This form was designed for use at stations with <br /> inspection fumed up equipm <br /> Coaxial or 2-Point Phase I with'Balanoe Phase If Record descriptions of the noted defects and repairs on-the;DaftyRepair Log; accessible in the Operations&Maintenance,Manuel for Inspection <br /> vapor recovery . .Puce aChook mark in Record your Weals at the bottom of the form after 6ompletirig each days by the Air Poiiution'Control District for a period of at feast two Yam- <br /> each box where your inspection revealed no Inspebti.m. Keep copies of work orders and/or equipment part receipts <br /> problems,and ari'X'in each box where your <br /> Da of the Month <br /> Use TRAFFIC CONES and SAFEfY'VESTS) 1 2' 3 4 5 6 7 8 9. 1®.11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 3; <br /> ,, K AREA <br /> Vent4lne PV valve s - ueserrt llowsticker,nova 'rshadows• <br /> 2 Spill containers-clean and d <br /> s.S III�ntainer drains-OPenffbve and closed chain attached rt a llcab/e ' <br /> 4.Vkp2r a s- askets iesent&Vgh4 caps not rnissbg,broken or loose77 <br /> 5.Vapor ads tars-11 ht'on riser d brew pqpoatis not missin darns ed <br /> s. FIR ca - askets resent and tightoa•s not unissin broken dr Bose <br /> .F. ,V, <br /> 7. Fill adapters-attached 8 htl to riser inside asket not missing or tom <br /> o� Loo <br /> Vr <br /> a. Fill tube coaxial cin -loaded resent round,jeting not broken orsaggLng. <br /> e.Coaxial gasket-in place,seal 22!2ors <br /> to.Fill tube- 2-Point resent round' _J77t7J=L__ <br /> DISPENSER <br /> ound- <br /> DISPENSER AREA <br /> 113r district decals le ible eratin Instructions,correcf com—plaint hone# <br /> Hoses'-CARB-a roved,no idnksitearsts,LRD installed correctly !! i <br /> 1 <br /> LA <br /> 13.Breakaways-CARB-a roved,no li uid staWdust.buildu <br /> m. Nozzles-CARB�a roved has a#clam s,swivels work smoothy,no leaks <br /> 15.Nozzle bold-o en latches resent and eratm oorreatl <br /> ts. Nozzle bellows and face lutes-tight on noz7Je no tears/sllts, cod seal <br /> Loo <br /> 17. Nozzle spouts-not loose not out-of round have latch devices <br /> LO <br /> ta. Nozzleva rwalves nc va rsbadows emltfin from iuozzle <br /> ta.Nos Retractor- uasentwlfh a to,or hose unless LRD present <br /> Ih8PECTAT ,ONCE1�ER; <br /> . <br /> 20 r hose <br /> k -r '". ': ,.•u*. .�nwa�a. a'-F-f� q -w s. .- T .���� t t <br /> gglxgL <br />