Laserfiche WebLink
/l. CALIFORNIA DAILYIWEEKLY GASOLINE SYSTEM INSPECTION FORM <br />�,,�,,,,,__�� // (satisfies all CA Air District inspection requirements including South Coast AQMD's Rule 461) <br />Month1Year��ii/A_ Storatuase#1 007 1 111 21 31 41 51 61 71 Of 9,10111;12113 14, 151 161 171 itif 191 201 21i 22i23124! 251 261 27i 28i 291 30i 31 <br />1-1 • --- V---1-- Y..--- --d C...i..-1- _.. <br />1 Dispenser decals resent? <br />2 Hoses -no kinks, flat spots, or tears. Hose correct length. <br />/ 'i ^ <br />I - ' l ' ` ' i ' " ' • ' 1 r i r 1 ! - 1 1 ! i1 ' ! <br />3 Swivels operational, no drips or leaks. <br />4 Breakawayand hose Installed in the correct direction. <br />Weekly - dispensing rate between 7-10 gallons per minute (recommended <br />daily). <br />i <br />8 Nozzles -no drips or leaks. <br />/ �! ' ' ' ` ' ' "j - ' ! ` 1 / i % �'• ' r 1 r" - ! <br />- 1 A <br />7 Nozzles -shut off properly/hold open latches operational? <br />8 Nozzles are free of dents. <br />' 1 - �1 - • 1 / ' ' i / i = ' - .� i _ �` <br />' 1 ' i <br />9 System is free of unusually strong vapors and gasoline odors. <br />i �_ ' 1 ' 1 ! 1 I �1 .►i ! ' ! - r - ! / r �' i i <br />'' ! <br />10 If applicable, retractors working property? <br />' ` ' ': ` "' ' t " ' ' ! i ! <br />Balance Systems mark this section "NA" If your site Is not a balance system booted nozzles <br />Balance Nozzles bellows are on tightly. No tears, slits, or holes In the bellows <br />11 not to exceed 0.5 Inch triangular tear or hole or 1 Inch splitle <br />12 Balance Nozzles- Faceplate smooth, not torn, forming a Ug t seal with the <br />vehicle. <br />13 Balance Nozzles -Spout ring presentlinsertion interlock me anism is <br />functioning tri er is loose when bellows are not com res <br />1 <br />14 Week -balance hose has has been checked and drained. I <br />! i I t I I A I 1 1 1 11 <br />1 i <br />Vacuum -Assist Systems mark this section "NA" If your sit Is not a va um -assists stem n les have ei er a mint-illoot or noboot) <br />15 Vacuum -Assist nozzles-spourt spring resent, vapor recoveri holes cleat. <br />16 Vacuum -Assist nozzles- all of the nozzles on the same side f the disp nser <br />are similar, either all with a mini -boot or without a minboot <br />17 Vacuum -Assist nozzles -if required, mini -boot present and in g <br />18 Ba !bulb test recommended but not required by law . <br />DATE: INITIAL: DATE: INITIAL: <br />Underground Storage Tanks <br />19 Vapor and fill spill buckets are free of all liquid and debris? Drain valve isJ, <br />operational. <br />,/: !' :.:.a i�'� �'��i 1 ri iii'', <br />I ' <br />s s <br />20 Are the fill/vapor caps and gaskets in good conditioniclamp ontightly? <br />'1 4 ' i ' t' ' 'i + 1 '! ' rI -1 ' i'i ! '! I ' ! "4! `i <br />21 Are the fill and vapor fill adaptors on tightly/free of cracks and debris?22 <br />Is the fill tube in good condition -no cracks or dents? Gasket Installed between <br />the collar and dro tube? <br />23 Is the fill tagged to properly identify product in the tank? <br />, <br />' <br />Do gasoline tank vent pipes have pressure vacuum (PN) valves? Do the PN <br />24 <br />valves have a visible sticker that states "Press. 3 inch 8 Vac. 8 inch"? <br />j ! i '• . ' ` i ' ! '• 1" ' - ' `i <br />i- : moi. �1 �; %.. [ - i r: ,.i �:�. � 1 - 1 i t <br />1 ' ' i ! 'i i I I ! i ! I <br />25 1 Drybreak et valve seals properly <br />In the Store <br />26 Are all permits and conditions posted, current and adhered to? <br />Electronic monitors -Monitoring system is on and free of alarms. If applicable, <br />27 monthly test results are available. <br />28 Are daily gasoline records up-to-date, accurate andpresentable? <br />' <br />29 Are vapor recovery (Stage II test results available? <br />1 1 A A 1 -' "'I -i- 1 i "T i r i �' ! .i 1 �'1--1 - i 1 -1 <br />Weekly Hazardous Waste and General Housekeeping <br />30 Hazardous meterialstwaste storage area free of spills and leaks? <br />A I r I 1 - t <br />31 Are drums/chemical containers labeled with contents <br />32 Yard area free of debris, safety hazards? <br />'l 1 ' I ' I I I / 1 't A - <br />33 Drums in good condition no leaks severe rust or drum heads bulging? <br />i 11 <br />34 Is the accumulation date shown on Hazardous Waste drum decals? <br />r �! I I i I r / i1 -! i ! ! - ' ' ! / �! ! i " i <br />r.......,rr.,. r_r%.d"r-t.a 9vrtniftetst <br />te.r .i dhr .r'I4r .d..t :/': <br />Place a"J" for compliance items and an "X" for non-compliance items. For non-compliance items, comp e the Repair Log. <br />Place noncompliance items out of service and contact Tim Skovensky at 916425-7870 or Tom Upton at 916-281-8958. <br />Farre 00950A rev. 10J02 <br />0 <br />