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' Month/Year <br /> t <br /> Inspection <br /> � Station Name:Address: Ce <br /> V: CoaxiaV 2-Point Phase I and Balance Phase 1.1 Vapor Recovery Systems Facitity PTO#: <br /> This form was designed for use at stations with inspection tumid 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 II 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 aCheck mark in Record your initials at the bottom of the form after completing each day�s 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 /> Da of the Month <br /> (Use TRAFFIC CONES and SAFETY VESTS) 112 1 3 4 5 16 7 8 9 10.11 12 1311411'51 <br /> 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 �'. <br /> AN K AREA <br /> Vent-line PV valves) -present, ellowsticker,no va orshadows <br /> f/ <br /> 2. Spill containers-clean and dry <br /> v <br /> 3. S III container drains-o eradve and closed,chain attach- 01 <br /> if a licable <br /> 9.0 <br /> a. Va or ca s- askets resent&fight,caps not missln ,broken or loose <br /> 5. Vapor ada tars-li ht'on riser,d break .oppet is not rnlssin lama ed <br /> v <br /> s. Fill caps-caskets pressrrt and tight,ca's not missing broken or loose - <br /> .00 <br /> 7. Fill ada ters attached tight/v to riser,inside 2asket not missing or tom <br /> S. Pill sa 47a. <br /> s. asket-in lace,seam ` <br /> 10. Fill tube- 2-P2int resent round <br /> DISPENSER AREA <br /> . voo :r <br /> ATr district'decais=legible eratin Instnetions,correct complaint hone# <br /> Hoses'-CARR-a roved no lanksitears/sffs,LRD installed correct) <br /> 13. Breakaways-CARB-a roved no liquid• stairiftst.buildu <br /> 14. Nozzles-CARB-appTved has all clamps,swivels work smoothly,no)eaks <br /> ts. Nozzle hold-o en latches resent and operadhocorreC `� ✓ <br /> 16. Nozzle bellows and face fates-ti ht on noaJe,no tears/sllts,good seal f <br /> n. Nozzles outs-not loose not out-of-round,have latch devices <br /> 18. Nozzle vapor valves-no va orshadows emitti from nozzle 60 <br /> t s. a rac or- resent with a W orless h e e <br /> INSPECT AT LEAST ONCE PER:WEEK <br /> 20. Drain vaDor hose to remove excessive amen": <br /> INSPECTORSRd�IriALS: <br />