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ARB Approved IOM-HealyNeeder-Root Phase II EVR System-VR-202-A(Scheduled Maintenance) el a r- o VR-202-A - Weekly Inspection ti Checklist Checklist results may be used to assist with filling out GDF maintenance log. Date: 1/1,8/2013 Page 1 of 1 Dispenser Unihose or Fuel Grade Nozzle Hose Breakaway VP1000 Vacuum Pump Normal Operation Number (select one) Inspection Inspection Inspection select one (select one) ( ) (select one) (select one) 1 t*Unihose r 87 r 89 r 91 r Other re Pass r Fail ro Pass r Fail ro Pass r Fail ro Pass r Fail 2 re Unihose r 87 r 89 r 91 r Other 0 Pass r Fail r Pass r Fail d+Pass r Fail re Pass r Fail 3 re Unihose r 87 r 89 r 91 r Other ro Pass r Fail r Pass r Fail re Pass r Fail r Pass r Fail 4 0 Unihose r 87 r 89 r 91 r Other rq Pass r Fail r Pass r Fail re Pass r Fail 4+Pass r Fail 5 G Unihose r 87 r 89 r 91 r Other ro Pass r Fail r Pass r Fail ro Pass fi"'Fail r Pass r Fail 6 r Unihose r 87 r 89 r 91 r Other ro Pass r Fail r Pass r Fail t+Pass r Fail ro Pass r Fail 7 to Unihose r 87 r 89 r 91 r Other rw Pass r Fail ro Pass r Fail re Pass r Fail re Pass r Fail 8 to Unihose r 87 r 89 r 91 r Other ro Pass r Fail t*Pass r Fail to Pass r Fail !`o Pass r Fail 9 1 o Unihose r 87 r 89 r 91 r Other ro Pass r Fail �o Pass r Fail tr Pass r Fail ro Pass r Fail 10 to Unihose r 87 r 89 r 91 r Other re Pass r Fail ro Pass r Fail to Pass r Fail ro Pass r Fail 11 r* Unihose r 87 r 89 r 91 r Other ro Pass r Fail f+Pass r Fail ro Pass r Fail ro Pass r Fail 12 G Unihose r 87 r 89 r 91 r Other ro Pass r Fail r* Pass r Fail ro Pass r Fail �o Pass r Fail r Unihose r 87 r 89 r 91 r Other r Pass r Fail r Pass r Fail r Pass r Fail r Pass r Fail r Unihose r 87 r 89 r 91 r Other r Pass r Fail r Pass r Fail r Pass r Fail r Pass r Fail r Unihose r 87 r 89 r 91 r Other r Pass r Fail r Pass r Fail r Pass r Fail Pass r Fail r Unihose r 87 r 89 r 91 r Other r Pass r Fail r Pass r Fail r Pass r Fail r Pass r Fail WO:2308165