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I. 'Y• 11" <br />' Station Naas: ' <br />Inspection Ch6eklistp J Address: Coax <br />CoaxiaU 2 -Point Phase I and Balance Phase ll,Vapor Recovery Systems <br />This form was designed for use at stations with inspection turned up equipment defects or other issues req hDring further action. related to the noted repairs vrith the Log. keep these records <br />Coaxial or 2 -Point Phase t with Balance Phase 11 Record descriptions of the noted defects and repairs on the Daily Rep& Log.., -`accessible In the operations & Maintenance Manual for in <br />vapor recovery systems. Place aCheck mark in Record yore initials at the bottom of the torn after completing each day's , ^ by the Air Pollution Corilml District for a period of at least hvo years. <br />each box where your inspection revealed no inspection. Keep copies of work orders and/or equipment part receipts <br />ff1. Vent line P\/ valve(s) -pnssent, yefbw stkker, no vapor shadows <br />Spill Fy W, <br />�7z�Splll cordainers -clean and d)y <br />z Spill container drains-openolve and closed chain attached Of aPPH-t <br />a. Vapor caps -gaskets present & tight, caps Rot missing, broken or kroM <br />s. Vapor adaptenvb on riser, dry break poppet Is not mtssing1damags <br />a. Fit caps - gaskets present and fight, caps not missing broken or loose <br />7. Fill adapters attached tightly to user, inside gasket not massing or tom <br />us <br />Fill tube (coaxial spring-toaded) present, round; spring not broken ors <br />s. Coaxial gasket do place, Seating vapors <br />in. FM tube - (2 -Point) ptesent, round <br />t 1. Alf district decals - legrbte opeiatin9 instnrctions, correct complaint phone # <br />12. Hoses - CARB-aWoved, no klnksAtearslslits. LRD installed conecdy <br />ta. Breakaways -CARS -approved, no llq&id sfainldust bulldup <br />p4.Nozzles - CARB-epproved, has all stamps, swivels work smoothly, no teaks <br />is, Nozzle hold -open latches Vasent and operating oormolly <br />Is, Nozzle bellows and faceplates flight on nozzle, no fearslsids, good seat <br />17. Nozzle spouts -not loose, not out -of -round, have latch devices <br />is. Nozzle vapor valves -m vapor shadows emitAng tram nozzle <br />Its. Hose Retractor -present va a 10' or Less hose krop unless LRD present <br />WgPECT AT LEAST ONCE PER WEEK <br />INSPECTORS INITIALS: <br />