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1 <br /> Inspection <br /> ulonrnNear. ® dStation Name: L--R1Checkli Address: a!57 0. <br /> Coaxial/2-Point Phase I and Balance Phase 11 Vapor Recovery Systems t a <br /> o This form was designed for use at stations with Inspection turned up equipment defects or other issues requiring turther action. related to the noted repairs,,vith the Log. Keep these records <br /> �- Coaxial or 2-Point Phase I vrith Balance Phase II Record descriptions of the noted detects and repairs an the Daily Repair Log. •''accessible in the Operations&Maintenance Manual for inspection <br /> vapor recovery systems. Place&Check mark In Record your Initials at.the bottom of the form after completing each day's by the Air Pollution'Controi District for a period of at least taro years. <br /> each box where your inspection revealed no Inspection. Keep copies of work orders a ndlor equipment part receipts <br /> problems,and an'W'In each box where your <br /> �/ f�/•./.1�✓ ✓ � t e Month <br /> (Use TRAFFIC CONES and SAFETY VESTS) 'f 2 3 4 5 6 7 5' 9 1011 i 12113 1415 1l3 M th f 9 2fl 21122123124125126127128129130 31 <br /> TANK AREA <br /> 1.Vent line PV valves)-present yellow slicker,no vapor shadows <br /> 2.Spill containers-clean and dry <br /> 3.Spill container drains-operative and closed,chain attached(yapphhable) cl .� . <br /> a.Vapor caps-gaskets present&tight,raps not missing,broken or loose ✓ ✓ ✓ <br /> s.Vapor adapters-trght an riser,dry break poppet is not missingldamaged ✓ ✓ ✓ <br /> 0 <br /> =� R. FRI caps-gaskets present and light,caps not missing broken or loose IA <br /> CC r.FIA adapters.attached tightly to riser,inalde gasket not missing or tom ✓ ✓ <br /> w R.FIG tube(coaxial spring-dens)present,round,spring not broken or saggung ✓� <br /> s.Coaxial gasket-ln place,seeCng vapors 17 71 ✓ <br /> 10. Fill tube:(2-Polno present,round <br /> DISPENSER AREA <br /> 11.Air district decals-legible operating in imfkans,correct complaint phare# <br /> 12. Hoses-CARS-approved,no kfnks4ears(sh1s.LRD installed correctly V-V V ,✓ - ./ <br /> 13. Breakaways-CARSapproved,no liquid stain/dust buttdup ✓ t <br /> 14.Nozzles-CARBapproved,has all clamps,swtvets work smoothly,no leaks ✓ <br /> 1s.Nozzle hold-open latches-presenl and operaling correctly � <br /> 16.Nozzle bellows and faceplates tV#on Nozzle,no tear&wfts,good seat ' <br /> 17.Nozzle spouts-not loose,not out-cfrovncd have latch devices ✓ `'f °✓ <br /> ¢ 1a.Nozzie vapor valves-no vaporshadows emifiing from nozzle 4/ <br /> 19.Nose Retractor-present to a 10"orless hose loop unless LRD present ✓ <br /> CO INSPECT AT LEAST ONCE PER WEEK <br /> C=) <br /> 2o.Drain va or hose to remove excessive gasoline <br /> 0 <br /> INSPECTOR'S INITIALS, <br /> m <br /> 0 <br /> hl <br /> Lc7 <br /> a'. <br />