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Inspection <br />i Month/Year:0 Station Name: - `3 Z (X <br />o Address: /W a <br />Coaxial/ 2 -Point Phase I and Balance Phase IJ Vapor Recovery Systemsara i <br />d <br />m <br />Cy') <br />00 <br />0 <br />0 <br />N <br />0 <br />N <br />g9+ <br />N <br />Uc1 <br />cn <br />This form was designed for use at stations wfth Inspection turned up equipment defects or other issues requiring further action. related to the noted repairs NVM the log. Keep these reoords <br />Coaxial or 2 -Point Phase I %Htlh SManee Phase tl Record descriptions of the noted defects and repairs on the Daily Repair Loy. accessible In the operations & Maintenance Manuel for Inspection <br />vapor recovery systems. Place aCheck mark in Record your iinitials at the bottom of the form after completing each day's by the Alr Pollution Control District for a period olai least tyro years, <br />each box where your inspection revealed no Inspection. Keep copies of nrork orders and/or equipment part reu.-Ipts <br />problems, and an "X" in each box where your ` o� <br />of <br />(Use TRAFFIC CONES and SAFETY VESTS) 112 13 4 5 16 17 18 19 11011111211311411F,1161171-19114 20 21 9a ,3'd 9x7 Q1?7T R1Q[ <br />