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V <br /> Checklist <br /> a Month/Year: Q <br /> Station Name: vInspection Address: <br /> Coaxial/2-Point Phase I and Balance'Phase 11.Vapor Recovery Systems aci1 <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 1 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 fora 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 r J <br /> (Use TRAFFIC CONES and SAFETY VESTS) E2 3 14 15 1,6 17 18 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 <br /> TANK AREA <br /> 1,Vent line PV valve(s)present,yellow sticker,no vapor shadows `� k/ v ✓✓ V1✓ ✓ ,jf ✓v/ <br /> 2.Spill containers-clean and dry ✓✓ ✓ ✓ ,f V <br /> 3,Spill container drains-operative and closed,chain attached(if applicable) ✓ ✓✓ ✓ I/ <br /> a.Vapor caps-gaskets present&tight,caps not missing,broken or loose ✓ ✓ 1/ (/ <br /> s.Vapor adapters-tight on riser,dry break poppet is not missingJdamaged �/✓ ✓ I/ <br /> s.Fill caps-gaskets present and tight,caps not missing broken or loose 1I� ✓ ✓ ✓ t f <br /> 7.Fill adapters-attached tightly to riser,inside gasket not missing or tom ✓ t✓ V <br /> t1. Fill tube(coaxial spring-loaded)-present,round,spring not broken orsagging ✓ �/1f ✓ ✓ <br /> o.Coaxial gasket-in place,seating vapors tf ✓✓ ✓` ✓ ✓ ✓ <br /> io. Fill tube-(2-Point)present,round <br /> DISPENSER AREA <br /> Air district decals-legible operating instructions,correct complaint phone# ✓ ✓ <br /> 12. Hoses CARB-approved,no kinks4eaWslits,LRD installed correctly ✓ ✓ ✓ ✓ ✓ <br /> 13. Breakaways-CARB-approved,no liquid stain/dust buildup ✓ ✓,,- ✓ �. <br /> 14. Nozzles-CARB-approved,has all clamps,swivels work smoothly,no leaks too V V,1 ✓ ✓ V ✓ <br /> 1 s. Nozzle hold-open latches-present and operating correctly �j ✓ ✓ v <br /> r <br /> 16.Nozzle bellows and faceplates flight on nozzle,no tears/slits,good seal ' <br /> 17.Nozzle spouts-not loose,not out-of-round,have latch devices ✓ ✓ V <br /> 1 R.Nozzle vapor valves-no vapor shadows emitting from nozzle ✓ ✓ ✓ ✓ ✓ <br /> 19, Hose Retractor-present with a 10"or less hose loop unless LRD present 7✓ <br /> INSPECT AT LEAST ONCE PER WEEK <br /> 20. Drain vapor hose to remove excessive gasoline 95 <br /> INSPECTOR'S INMALS: •� + • • - f "� h <br />