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v <br />Inspection <br />Checklist <br />MontWYear. _0 <br />Station Name: <br />CoaxlaW 2 -Point Phase 1 and Balance�Phase 11, Vapor Recovery Systems aria` �; tv <br />This form was designed for use at stations with Inspection (taned 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 fhe bottom of the form after completing each day's " by the Air Pollution Control District for a period ofat least two years. <br />each box vdiere 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 />(Use TRAGIC CONES and SAFETY VESTS)11121314151617'— 9 90 11 12 13 14 75 16 171111191201211 <br />22 Z3 24 25 26 27 28 Z9 3(i 31 <br />TANK �cRE4 <br />1. Vent line PV valve(s) -present yellow sticker, rro vapor shadows <br />✓ <br />✓ <br />L/ �� ✓ V �/ <br />y, <br />2. Spilt containers -clean and dry <br />, / ,/V <br />V f ,/ <br />f f f f <br />✓ �r <br />s. Spill container drains -operative and closed, chain attached (ifappticabie) <br />✓LJ,/,/✓ <br />�/ <br />f , f ti/ <br />r,/ r/ <br />, ,P <br />o. Vapor caps -gaskets present a tight caps notmissing, broken or loose <br />''� ,f <br />✓ ,/ �/ ,/" ✓ v ✓ f c/ <br />o/ `/V <br />V, . <br />✓ <br />s. Vapor adapters -fr ht on riser, dry break poppef is not missing/damaged <br />V�% <br />✓ f ✓ ,/ �/ <br />f , f <br />✓ ,/ +/ <br />, <br />s, FSI caps -gaskets present and tight, caps not missing broken or kswe <br />✓ a/ t/ <br />, f `J <br />✓ k � <br />� � <br />V <br />7. FRI adapters attached tightly to riser, inside gasket not missing ortorn <br />✓ t% <br />v/ ✓ ✓ f <br />f <br />„/ <br />✓ �, <br />a. Fill tube (coaxiat spring-foaded) present, nwnd, spring not broken yr sagging <br />„� <br />✓ / <br />✓ J <br />s. Goaxiai gasket -til place, seating vapors <br />i/ <br />t <br />. �/ r,/ 7 f <br />✓ <br />/ ✓ ✓ ✓ <br />✓ta. <br />FiH tutx' -(2-Point) present, ramd <br />v <br />,r+ �/ <br />f <br />✓ ✓ `/ ti/ <br />`j' <br />+l ✓ <br />N1BMrtenrw aerr• .� - • <br />Air district decals -legible operating instructions owrect cot <br />Hoses - CARB.approved, rw kinksRears/sMs, LRD krstaued <br />,a Breakaways -CARBapproved, no liquld stabWust btrridup <br />sa_ Nozzles - CARB-apptaved has ail clamps, J*Wwts Loot* smoofhli <br />1 s. Nozzle hold -often latches present and operafkrg correctly <br />is. Nozzle bellows and faceplates fight on nozzle, no teamIslits, goo <br />17. Nozzle spouts -not loose, not ouf-of-row;o;_have talch devices <br />i s. Nozzle vapor vatves -no vapor shadotms emitting from nozzle <br />1 s. Hose Retractor -present wdh a 10” or less hose loop unless LRS <br />no Wks <br />seal <br />a=- <br />ry <br />Co <br />N <br />0 <br />w <br />0 <br />Co <br />9 <br />