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Checklist <br /> e Month/Year: <br /> Inspedion Station Name: <br /> Address: X <br /> Coaxial/2-Point Phase I and Ba{ance'Phase II.Vapor Recovery Systems 50' <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 II Record descrJptions 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 /> Day of the Month _ <br /> (Use TRAFFIC CONES and SAFETY VESTS) 112 3 4 5 fi 7__[_B 9110111112113114115116117118119 20 21 22 23 24 26 26 27 28 29 30 31] <br /> TANK AREA <br /> ANIL s.Vent line PV valve(s)-present,yellow sticker,no vapor shadowsqW <br /> z.Spill containers-clean and dry ✓✓ f <br /> a.Spill container drains-operative and closed,chain attached(if applicable) ✓ J 7 „ <br /> a.Vapor caps-gaskets present&tight caps not missing,broken or loose ✓ <br /> s.Vapor adapters-tight on riser,dry break poppet is not missing/damaged /✓✓ t/ <br /> 6. Fill caps-gaskets present and tight,caps not missing broken or loose ✓ ti./ ./ <br /> r.Fill adapters attached tightly to riser,inside gasket not missing or tom ✓ t/ <br /> n.Fill tube(coaxial spring-loaded)present,round,spring not broken or sagging Wo Wo✓ j <br /> s.Coaxial gasket-in place,sealing vapors tf f f✓✓ _�I <br /> it). Fill tube-(2-Point)present,round <br /> DISPENSER AREA <br /> I+.Air district decals-legible operating instructions,correct complaint phone# ✓ _ <br /> 12. Hoses-CARS-approved,no kinksltears/slits,LRD installed correctly ✓ ✓ <br /> ra. Breakaways-CARB-approved,no liquid stainldust buildup ✓ ✓ <br /> P <br /> AM <br /> oa. Nozzles-CARB-approved,has all clamps,swivels work smoothly,no leaks ✓ ✓ ✓ <br /> is, Nozzle hold-open latches-present and operating correctly J J ✓ <br /> Is. Nozzle bellows and faceplates Sight on nozzle,no tears/slits,good seal A( <br /> rr.Nozzle spouts-not loose,not out-of-round,have latch devices <br /> e� <br /> is. Nozzle vapor valves-no vapor shadows emitting from nozzle t/✓ <br /> in, Hose Retractor-present with a 10"or less hose loop unless LRD present 77✓ `I <br /> INSPECT AT LEAST ONCE PER WEEK <br /> zn. Drain vapor hose to remove excessive gasoline <br /> I <br /> INSPECTOR'S INITIALS: •f <br />