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Inspection Checklist <br /> _ Address. �j1.7�- <br /> Coaxial/2-Point Phase I and.Balance Phase'[] Vapor Recovery Systems qac 1 <br /> This form was deslgi for use at stations with Inspection turned up equidment defects or other issues rerluinng further actio relatpd to the noted repairs with the Log. Keep these recoms <br /> Coaxial o'2-Point Phase I with Balance Phase It Recon)descrotions of the noted defects and mpairs on the.Daily Repair I.up accowthle In the Operations 8 Maintenance Manua'for Inspection <br /> vapor recovery systems. Place aCheck mark in Record your initials at the bottom of the form after completing e0ch day's by the Air Pollution Control District for a period of at least Iwo years <br /> each box where your inspection revealed no inspection Keep coples of work orders and/or apapment part receipts ' <br /> problems.and an-X**in each box where your <br /> r Da of the Month _ <br /> (Use TRAFFIC CONES grid SAFETY VESTS) 1 2 3 4 5 6 I�8 9 10 11 12 13 14 15 16 17 18 19 20I21I22 23 24 25 26I27[28I29 30 <br /> TANK AREA <br /> I Vent line PV velvets)-present yellow sticker.no vapor shadows <br /> 1 Spill containers-clean and dry �/ I - - - v _v V -- t r <br /> a Spill c"lainer drains operative and closed.chain attached pt.applicable) V L/ / v <br /> x Vapor caps gaskets present 8 tight.caps not missing.broken or loose y Vi' vV V v (/ <br /> 5 Vapor adapters-fight on nser. dry break puppet Is not missmgzdemai f <br /> 1i 1-ill caps-gaskets present and tight. rape not misamg broken or loose L_/ V -- - ._... _1/ <br /> w ... <br /> r 1'ill adapters allachad tightly to,,see isde gdskef not imi or tom �/ VIV/ V <br /> 9 vvv__ <br /> it I dl tube(coaxial spring-foaded)present round,spring nor broken or saggar <br /> I I (.oaxlal gasket-in place. sealing vat ✓ V V <br /> w flu tube-f2-Pont)present. round <br /> DISPENSER AREA <br /> 4i nu district decals-legible operatrny u,shuGlions correct complaint phone IIt. V vvVV V v viviiii <br /> - - <br /> z Hoses-CARE-appmved.no kinks fearszshts LRD Installed correctly V ✓ V V <br /> u Breakaways CARE-appmved,no/rgatd slaa✓dusl buiklup <br /> tx Nozzles-CAR"pinnoved.has all clamps. swivels work smoothly.no leaks / • <br /> 15 Nozzle hold-open latches 1"sen/and operating correctly V V V <br /> Ie Nozzle bellows and faceplates fight on nozzle.no fears/slits.good seal V v <br /> I r Nozzle spouts-not loose,Trot out-ol-round,have latch devices V NJ✓ 1A 3Z V V <br /> Ie Nozzle vapor valves no vapor shadows emitting from nozzle y J <br /> it, Hose Retractor-present with a 10'or less hose loop unless LRD presentVIVIIUV V/t <br /> _ ___ _./ - _. <br /> INSPECT AT LEAST ONCE PER WEEK <br /> 1eE-ovae2r hose to remove exr' ssive gasoline UERM <br /> INSPEGTO :'51NITIALS: y <br />