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(f Month/Year: <br />■ /�`9�� '��Station Name: <br />Inspection Checklist yy� � Address: � <br />/ Facility PTO : <br />Coaxial/ 2 -Point Phase I and Balance Phaso II Vapor Recovery Systems <br />cc rdslated to the noted repairs with the <br />This form was designed for use at stations with inspection turned np equipment defects or of the noted defects and other <br />Issues <br />requiring <br />iringDailfurther <br />action. <br />accessiblecessible In the Operations & Malntenanoeep these e Manual foe <br />Inspection <br />re <br />Coaxial or 2 -Point Phase I with Balance Phase II Record descriptions <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 />Inspection. Keep copies of work orders and/or equipment <br />each box where your Inspection revealed no part receipts <br />problems, and an—V in each box where your <br />Dav of the Month <br />(Use TRAFFIC CONES and SAFETY VESTS) <br />TANK AREA <br />intline PV valves) -present yellowsticker no vaporshadows <br />2 Spill containers -clean and dry <br />s Spill container drains -operative and closed chain an"ched(itapplIcable <br />4 Vapor caps - gaskets present & tight caps not missing, broken or loose <br />s Vapor adapters - tight on riser, dry break poppet Is not missing/damaged <br />s Fill caps gaskets present and tight caps not missing broken or loose <br />7 FIII adapters -attached tghtly to riser, inside gasket not misslnq or torn <br />e Fill lube (coaxial spring-loaded) fresent round slI not broken or se <br />s Coaxial gasket -In place sealing vapors <br />Io. FIII tube - (2 -Point) present round <br />INSPECT AT LEAST ONCE PER WEEK <br />20 Drain vapor hose to remove excessive gasoline <br />INSPECTOR'S INMALS:. <br />FIII <br />III�i��1�11111�11�1�111� <br />11� <br />11� <br />1 <br />���e�lll\1�1�� <br />■it1111�11�1��1te11i <br />��lllll,�l���lllli■ <br />� <br />11!■ <br />_ ... ..:....:...... ... <br />t11111�1�111111111O.OI�IIII <br />. _. .-:........ .. .. ... <br />�IIII���IIII�IIII���It111O <br />. . . . . . . :............: <br />�il�l®®OIII�IIIIIt�®1 <br />.:.. .......... - . .:. <br />■Il�is��®Il�illllO®is1��1 <br />INSPECT AT LEAST ONCE PER WEEK <br />20 Drain vapor hose to remove excessive gasoline <br />INSPECTOR'S INMALS:. <br />