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Inspection Checklist <br />Coaxial/ 2 -Point Phase I and Balance Phase II Vapor Recovery Systems <br />Month/Year. <br />Station Name: —� <br />a c i I tty P 10 9: <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 Balance Phase II Record descriptions of the noted defects and repairs on the Daily Repair Log. accessible in the Operations & Maintenance Manual for inspection <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 />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 />_ Day of the Month <br />(Use TRAFFIC CONES and SAFETY VESTS) 1 2 3 4 5 6 17 18 19 110111112113114115116117118119120121122123124 25 26 27 28 29 30 31 <br />NK AREA <br />L <br />11. Air district decals -legible operating instructions, correct complaint phone # <br />12. Hoses - CARB-approved, no kinks/tears/slits, LRD installed correctly <br />. Breakaways -CARB-approved, no liquid stain/dust buildup <br />14. Nozzles - CARB-approved, has all clamps, swivels work smoothly, no leaks <br />15. Nozzle hold -open latches -present and operating correctly <br />1e. Nozzle bellows and faceplates flight on nozzle, no tears slits, good seal <br />17. Nozzle spouts -not loose, not out -of -round, have latch devices <br />18. Nozzle vapor valves -no vapor shadows emitting from nozzle <br />1g. Hose Retractor -present with a 10" or less hose loop unless LRD present <br />INSPFC'T AT I FACT nMr-r: PFA wGGu <br />2o. Drain vapor hose to remove excessive gasoline <br />INSPECTOR'S INITIALS- <br />.. Y■■INN <br />■■il111 m <br />IN <br />1111m <br />■ <br />■■ <br />... .. ....8 W.... �t1i■■un�I1i■■■Yn <br />■n■■�i��1I11��■■ <br />■■ <br />n■ <br />�I��■■I1n��1��i■■����ii■n■■I�� <br />n■n■11 <br />aim <br />...... .. . _ ...... ...... �I■■■i1■nn■■■nl�n��n■■n1���i��■■nn1�u <br />IN <br />.. .. ....... ����■■��■�In■■■ <br />I1lln■■■nn�■ <br />... .. ... ... ���� <br />11■11■��■■YIN11111�■■1111���' <br />n■■niln <br />��■ <br />.... ........ ......... ...1111■■11■■1!/1■■ <br />1100 <br />IN <br />. -. ..■Y■■I!■■Yt1■■Y■■■ft■■I11111 <br />NEON <br />L <br />11. Air district decals -legible operating instructions, correct complaint phone # <br />12. Hoses - CARB-approved, no kinks/tears/slits, LRD installed correctly <br />. Breakaways -CARB-approved, no liquid stain/dust buildup <br />14. Nozzles - CARB-approved, has all clamps, swivels work smoothly, no leaks <br />15. Nozzle hold -open latches -present and operating correctly <br />1e. Nozzle bellows and faceplates flight on nozzle, no tears slits, good seal <br />17. Nozzle spouts -not loose, not out -of -round, have latch devices <br />18. Nozzle vapor valves -no vapor shadows emitting from nozzle <br />1g. Hose Retractor -present with a 10" or less hose loop unless LRD present <br />INSPFC'T AT I FACT nMr-r: PFA wGGu <br />2o. Drain vapor hose to remove excessive gasoline <br />INSPECTOR'S INITIALS- <br />