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v <br />MonthNear: 0 <br />■ 1 Station Nar nw.- • _T 2 -4 1// ?"It <br />n <br />Address: Z 3 7 7WCK /$L v O <br />Coaxial/ 2 -Point Phase I and $alonce Phase 11 Vapor Recovery Systems Factfily <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 %vith the Log. Keep these records <br />Coaxial or 2 -Point Phase I vrtlh Balance Phase iI Record descriptions of (he noted defects and repaks on the Daily Repair Log, accessible in (he Operations & Maintenance Manual for Inspection <br />vapor recovery systems. Place aCheck mark in Record your Initials at the bottom of the form after completing each day's by the Air Pollution Control District for a period of at least two years. <br />each box vAiere your inspection revealed no inspection. Keep copies of vmrk orders and/or equipment part receipts <br />problems, and an "X" in each box where your / /`• <br />�✓l✓•✓ ✓✓,/, /`,/ ✓`✓ �/ Q/ ✓I7ay of the Month <br />(Use TRAFFIC CONES and SAFETY VESTS) <br />'AN K AREA <br />t. Vent line PV valves) preso <br />2. Spill containers -clean and <br />s. SpIll container drains -aper <br />a. vapor caps -gaskets Pr! <br />s. Vapor adapters -light on <br />no <br />,se and dosed, chain attached fif applicabi <br />& Udht, caps not missing. broken or loose <br />break <br />& Fit caps - gaskets pmsentand tight, caps not <br />7_ Fill adapters aflached fightly to riser, inside ga <br />a. Fitt tube (coaxial spring-loaded) mrresent, roum <br />s. Coaxial gasket -in place, seating vapors <br />1o. Fill tube - r2 -,Phut} present, rouW <br />nrQncucec aeaa <br />Is notnihskrgldamagr <br />ilssing broken orloose <br />ret not missing or ton <br />spring riot broken or s <br />91, Air district decals -legible operating Instructions, cormctcomplaint phone A <br />� <br />� <br />- <br />12. Hoses - CARB-approved; rro kinks/fears/slits, LRD installed correctly <br />I3. Breakaways -CARS-approved, no liquid stainldust buildup <br />- J ✓ ✓ V <br />is. Nozzles - CARS -approved, has all clamps, zwAmis work smoothly, no leaks <br />✓ <br />✓ ✓ <br />is, Nozzle hold -open latches -present and operating correc* <br />b.1✓ <br />`� ✓ <br />is. Nozzle bellows and raceplates light on nozzle, no tearaWift, good seal <br />v 7 V- <br />I7. Nozzle spouts -not loose. not out-of-roiM, have latatr devices <br />t/ �/' V <br />✓ <br />re. Nozzle vapor valves aro vaporshadows emitting from nozzle <br />lig. Hose Retractor -present with a 10" orless hose loop rsrless LRD:presenl <br />IPECT AT LEAST C <br />Drain vapor hose to <br />0411WTOR'S lNffiALS* <br />..b <br />0 <br />0 <br />