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AL- <br /> Inspection <br /> Checklist <br /> MonthrYeac Station Name: �/AL-1:go O Address: =Z3 1 h Ck C L'Q <br /> Coaxial/2-Point Phase I and BalanceVhase 11.Vapor Recovery Systems ac' o <br /> fits form vm3 designed for use at stations with inspection turned tip equipment defects or other issues fe iulring further action, related to the rioted repairs with the Log. Keep these records <br /> Coaxial or 2-Point Phase I with Balance Phase II Record descriptions of the noted detects and repairs on the Daily Repair tog. ''accessible In the Operations R Maintenance Manual for inspection <br /> vapor recavery,systems. Place aChack 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 inspeGion. Keep copies of work orders and/or equipment part receipts c o <br /> problems,and an' 'in each box where your <br /> ✓„� �/ v�✓ Day of the Month <br /> (Use TRAFFIC COMES and SAFETY VESTS) 1 2 3 4 5 6 7 18 19 1 Q 11 12 13 14 13 16 17 18 19 20 21 22 23 24 23 26 27 28 29 30 31 <br /> .TANK.AREA------------............- <br /> 5.Vent line PV valves)-present,yellow stinker,no vapor shadows ✓ ✓✓ '' v� ✓✓ <br /> z.Spill containers-clean and dry ✓ ✓ ✓ ✓ <br /> 3.Spill container drains-operative and closed,chain attached(ff applicable) ✓ ✓ R✓ ✓ V <br /> s.Vapor caps-gaskets present&tighC caps not missJng,broken or loose ✓ ✓ ✓ ✓ <br /> s,Vapor adapters-fight on riser,dry break poppet is not missing/damaged ✓ ✓-✓ /t/ / ✓ <br /> s,Fill caps-gaskets present and Bght,caps not missing broken or loose ✓ ✓ +! ✓ '✓ <br /> 7-FIB adapters ettached tightly to riser,inside gasket not missing or tom ✓ ✓ <br /> o,Fill tube(coaxial sp(ng-loaded)present,round,spring notbroken orsagglrtg ✓ ✓ <br /> 9.Coaxial gasket-inplece,sealing vapors ✓ ✓+✓ y_ <br /> io,Fill tube-(2-Paint)presenC round ✓ ✓ ✓ ✓ <br /> DISPENSER AREA do o <br /> ii.Air district decals-legible operating Instructions,correct complaint phone# ✓ ✓ ✓ Vi <br /> .m,Hoses-CARB-approved,no kFnWears/sMs,LRD Installed correctly 'vim✓ �// ✓✓ °� <br /> 13.Breakaways-CARS-approved,tro liquid stain/dust buikitip ,/ ✓ r <br /> 14,Nozzles-CARS-appmved,has aA clamps,stwvels work smoothly,no leaks V1✓ V 1f ✓✓ <br /> 15.Nozzle hold-open latches-present and operating correctly +/ ✓ ✓ _ <br /> is,Nozzle bellows and faceplates fight on nozzle,no tearsWfs,good seal r✓ ✓ y <br /> 17.Nozzle spouts•not kose,not out-of-round,have latch devices v <br /> 18.Nozzle vapor valves-no vapor shadows emitting from nozzle ✓ ✓ <br /> ta.Hose Retractor-present Mh a 10"or Jess hose loop unless LRD present7i��'/7 <br /> INSPECT AT LEAST ONCE PER WEEK � <br /> 2o.Draln vap2t hose to remove excessive gasoline <br /> 0 <br /> {rtsPIECrorrs MIAs: <br />