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® a MonthNear <br /> Station Name: <br /> Address: <br /> Inspection Checklist71) i <br /> Coaxial/2-Point Phase I and Salance�Phase II_Vapor Recovery Systems Facility t�® <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 with the Log. Keep these records <br /> Coaxial or 2-Point Phase I with Balance Phase 11 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 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 where 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 /> �✓ ✓ ✓✓ '✓`c/6 of the Month <br /> (Use TRAFFIC CONES and SAFETY VESTS) 1 2 3 14 1 5 6 [718:1910 111121131141151161171181191201211221231241251261271281291301311 <br /> TANK AREA <br /> i. Vent line PV valve(s)present,yellow sticker,no vapor shadows ✓ f ✓ <br /> Spill containers-clean and dry ✓ f✓✓✓ V <br /> Spill container drains-operative and closed,chain attached(inapplicable) Z7 ✓ ✓ ✓! <br /> Vapor raps-gaskets present&tight,caps not missing;broken or loose ✓ ✓ ,/ <br /> Vapor adapters-tight on riser,dry break poppet is not missing/damaged ✓ ✓ ✓ f <br /> Fill caps-gaskets present and tight,caps not missing broken or loose <br /> Fill adapters attached tightly to riser,inside gasket not missing or tom ✓ ✓ ✓ <br /> Fill tube(coaxial spring-loaded) ✓ <br /> _ •present,round, spring not broken orsagging <br /> i,. Coaxial gasket-in place,sealing vapors *! ✓ ✓f <br /> lint. Fill tube-(2-Point)present,round ✓I V1 ;�✓ ✓ <br /> DISPENSER AREA <br /> i i Air district decals-legible operating instructions,correct complaint phone tl ✓✓ <br /> j i_ I-loses-CARE-approved,no kinksltearslslits,LRD installed correctly ✓ ✓ ✓ ✓ ✓ J e/ <br /> s Breakaways-CARB-approved,no liquid stainldust buildup ✓✓ ✓ J <br /> �i.;, Nozzles-CARS-approved,has all clamps,swivels work smoothly,no leaks "� ✓✓ `� V <br /> I i._,. Nozzle hold-open latches-present and operating correctly ✓ 'f✓ <br /> r,, Nozzle bellows and faceplates•tight on nozzle,no tears/slits,good seal ✓ <br /> - Nozzle spouts-not loose,not out-of-round,have latch devices <br /> i. ' <br /> i r:, nozzle vapor valves-no vapor shadows emitting from nozzle `� k/ <br /> ui. Close Retractor-present with a 10"orless hose loop unless LRD present <br /> INSPECT AT LEAST ONCE PER WEEK <br /> ( o Drain vapor hose to remove excessive gasoline <br /> 4- <br /> I__ INSPECTOR'S INITIALS: <br />