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ist <br />Vfiv month/Year. ® — <br />Station N:arne." • 5 %7PO—Cci <br />'Inspection ChecklP 10 Address: M.t/ O <br />Coaxial/ 2 -Point Phase i and Balance Phase !i Vapor Recovery Systems a°"ty <br />This form was designed for use at stations with inspection turned up equipment deflects or other Issues requiring rwther action. related to the noted repairs with the Log. Keep these reCD1d5 <br />Coaxial or 2 -Point Phase I with Balance Phase II Record descriptions of the noted defects and repairs on the Daily Repair Loci. accessible in the Operations & maintenance manual for inspection <br />vapor recovery systems. Place aCheck mark in Record your inilials at the boltom of the form after completing eadi days by the Air Pollution Control District for a period of at least two years. <br />each box Miere your inspection revealed rw inspection. Keep copies of vrork orders arWor equipment part rea ipts <br />problems, and an ")Vin each box where your <br />(Use TRAFFIC CONES and SAFETY VESTS) <br />i. Vent line PV valve(s) -present yelfowsticker, no vapor shadows <br />V IV 4/ ✓ w <br />v v v ✓ v .i ✓ <br />%/:- v v- ,/ v V <br />V v y ,y <br />2. Spill contair m -as -clean and dry <br />✓ <br />V ✓ s/ <br />✓ V' <br />a, Spilt contalner drains -operative and closed, chain attached (N applicable) <br />✓ <br />✓ <br />d. Vapor caps -gaskets present & tight, caps not missing, broken orloose <br />t� t✓ <br />V V -'7 ✓ ✓ <br />3. Vapor adapters -tight on n'ser, drybreak poppet is not ntlssingldamaged <br />'� <br />`r <br />s. Fill caps - gaskets preseiit and tight, caps nal missing broken or loose <br />Vw I/✓ <br />✓ ✓ <br />7. Fill adapters -atlactwd tighby to riser, inside gasket not missing or tom <br />✓ <br />✓ <br />a. Fill tube (coaxial spring-loaded) prasenl, round springnofbroken orsainq <br />=/ ✓ <br />/ ✓ <br />f <br />a. Coaxial gasket -in ,Glace, sealing vapors <br />✓ t/ 7 <br />v' ✓ <br />✓ v/ <br />til j <br />1o. Fill tube -(2-Pon#) present, round <br />17 <br />'�/ ✓ '`�✓ <br />'/ 77—,77 <br />j <br />1 t. Air district decals -legible operating instructions, correct complain! phone # <br />12. Nwaes - CARE -approved. no kinksRearalslils, LRD instalied correc7y <br />13. Breakaways -CAR 9 -approved, tw liquid stain/dust buildup <br />14. Nozzles -GARB-approved, has all clamps, swivels work smog illy, no leaks <br />in. Nozzle hokt-open latches -present and operating correrWy <br />ts. Nozzle bellovis and faceplates dight on nozzle, no tearslslits, good seal <br />17. Nozzle spouts -not loose, not out -of -round, have latch devices <br />ra. Nozzle vapor valves -no vapor shadows ernilfing from nozzle <br />ta. Bose Retractor -present Wfh a 10`or less hose loop unless LRD present <br />tPECT AT LEAST ONCE PER WEEK <br />Drain vapor hose tote oveexcessive gasalir <br />INSPECTOR'S 7NMA L5: <br />r -- <br />a <br />