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a MonthtYear. <br />Station Name: t.0 <br />Address: " 3 `t r q C zv <br />FactillyPION: '-2.6 il� 5k <br />Inspecion Checklist <br />Coaxial/ 2 -Point Phase I and Balance Phase 11. Vapor Recovery Systems <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 %vith 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 aChack mark in Record your initials at the bottom of the form after completing each day's by the Air Poliution'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 whereyour <br />✓.�. /'_ / Dav of the Month <br />jttse TRAFFIC CONES and SAFETY VESTS) <br />TA.IV AnCA <br />1. Vent line PV valve(s) -present yellow sticker, no vapor shadows <br />✓ <br />z. Spill containers -clean and dry <br />✓ f ✓ <br />s. Spill container drains -operative and closed, chain attached (if applicable) <br />✓ <br />4. Vapor caps -gaskets present S tigb( caps oat missing, broken orloose <br />✓ .% f <br />s. Vapor adapters -tight on riser, dry break poppet is not missing/damaged <br />s. Fill caps -gasketi present and tight cans not missing broken orloose <br />Vol <br />7.Fgladaptersatlachedtighllytoriser,inside gasket notmissing orlom <br />*f <br />a. F11 tube (coaxial spring-loaded) presen( round, spring not broken orsaggtng <br />s. Coaxial gasket 4n place, seating vapors <br />io, Fill tube -(2 -Point) present, ro+md <br />DISPENSER AREA <br />i i. Air district decals - ieglble operaAng instrucb'ons, correct complaint phone a <br />12. Hoses - CARB-gaproved, no MhWears/stits, LRD installed correcity <br />i s. Breakaways -CARa-approved, no liquid sWnldust buildup <br />14. Nozzles - CARS -approved, has aN clamps, swivels work smoothly, no leaks <br />a <br />