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�..�' MonthfYear <br /> Inspection <br /> Address: - <br /> CoaxiaV 2-Point Phase I and Balance Phase 11 Vapor Recovery Systems <br /> fumed t de or other issues requiring further action. related-bo the noted with the Log..Keep t! records <br /> This form was ' ned for use at stations with inspection up airs on fhb Dally-Repair Log,' accessible in*the operations&Maintenanoe Manual for inspection <br /> Coaxial or 2-P61nt Phase I with' Phase 11 Record descriptions of the noted d and f90 etiri each epair by the Air Pollution"Control District for a period of at least two years. <br /> vapor revery systems. .Piece aCheck mark in Record your Initials at the bottom of the form after compl g <br /> dayq <br /> each box where your inspection revealed no Inspection.Keep oop: of work omi ars and/or equipment pad receipts. <br /> problems,and ari"X"In each box where your <br /> Dav of the Month <br /> (Use TRAFFIC CONES and SAFETYVE$Ts) 1 2 3 4 5 6 7 8 9. 16.11 1213 1415 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 <br /> J+IK AREA :. <br /> h.VenNine PV valve s <br /> -present tiow.sficker no!2 rshadows <br /> z Spill containers-clean and dry. <br /> Loo v <br /> •3.Spill container drains-operative and closed chain attached a lkable <br /> a.Va r ca a- skets iesent&ti hf not missin a broken or dose <br /> s. Va oda tars-tl ht'on riser d break o tis not missin dims Av <br /> s. FII askets resent and ti ht ca' not missln broken orloose <br /> 7. FB adapters-attached t! htl to riser,inside asket nct miss' or torn <br /> oo <br /> Co <br /> a. Fill tube coaxial spring-loaded) nt reseround,s rin not broken orsa in . <br /> s. <br /> --4--4— <br /> gasket-in a n va ors <br /> -Point resenf,round' <br /> DISPENSER AREA <br /> Air district decals°leq!ble eratin lnstructlons,correct complain° hone# <br /> 12 Hoses'-GARB-a roved,no knWears/slits,LRD Installed cor�ec77 <br /> 13. Breakaways-CARB-approved,no liquid stain/dust—buildupJ f77 <br /> 14. Nozzles-CARB-approved,has all clamps,swivels work smooth. ,no leaks <br /> ts. Nozzle hold-o en latchas resent and sratin correct! <br /> ts. Nozzle bellows and face lates tI M a on nozzle no tears/s/lts, oseal ; <br /> 17. Nozzles ou -notloose not out-of--round have latch devices' 7 LX <br /> tsr <br /> 1& Nozzle vapor valves-no va /shadows emithn from nozzle . <br /> INSPECT Al 7Tt,}NCE PGna $ .' .,;' •..a sy.... .._r=. ..&.".+ ; <br /> t y.. <br /> 20.Drainvapor hoes to IS 9! <br /> • e <br />