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l�Month/Year:— <br />��� jv"`' Station Name: <br />nspe.ction Checklist �� FAddress: <br />y <br />Coaxial/ 2 -Point Phase I and Balance Phaso 11 Vapor Recovery Systems <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 I with'Baiance Phase II Record descriptions of the noted defects and repairs on the Daily Repair Log; accessible In the Operations & Maintenance Manuai for Inspection <br />t thbottom of the form after . rnDleting each day's by the Air Pollution Control District for a period of at least two years. <br />vapor recovery systems. .Place aCheck mark in Record your initials ae <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 <br />i , , <br />(use TRAFFIC CONES and SAFETY VESTS) 2 3 4 5 6 8 9. 10 .11 12 13 <br />TANK AREA77,77 <br />vvv <br />Vent line PV valves resent, yellowsticker, no va dr shadows <br />i <br />Jj 2. Spill containers -clean and dry <br />C1u <br />1 3 Spill container drains -operative and closed, chain attached (if a llcable)1 <br />4 Vapor caps gaskets present& tight caps not <br />5. Vapor adapters -ti ht'on riser, dty break p oppe <br />s Fill caps gaskets present and tight, caps not <br />7. FIII adapters -attached t!ghtly to riser, insidea <br />e Fill tube (coaxial spring-loaded) -present round <br />s. Coaxial gasket -in place, sealing va ors <br />io. FIII tube 2 -Point resent, round <br />DISPENSER AREA <br />missing, broken or loose <br />. <br />t is not mIssin dama ed <br />missing broken or loose <br />sket not missIng or torn <br />spring not broken or sagglng <br />11, Air district decals 1legible operating instructions correct comph <br />Hoses- CARE -approved no kinks/rears/slits, LRD installed cor <br />13 Breakaways -GARB-approved, no liquid stain/dust.buildup <br />14Nozzles - CARB-approved has all clamps swivels work smoot <br />15 Nozzle hold -open latches present and operating correctly <br />16Nozzle bellows and faceplates -tight on nozzle no tears/slits, g <br />17 Nozzle spouts-notloose not out -of -round, have latch devices <br />i e Nozzle vapor valves -no vapor shadows emitting from nozzle <br />is Hose Retractor -present with a /0" or less hose loop Unless Lf <br />INSPECT AT LEAST ONCE PER WEEK <br />20 Drain vapor hose to remove excessive gasoline <br />INSPECTOR'S INMALS:. <br />phone # <br />/ <br />no leaks <br />seal <br />resent <br />of the Month <br />