COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

Tester's Name (print) Tester's Signature SHEAR VALVE OPERATION s Facility Name: Owner Address: Address City, State, Zip Code: City, State, Zip Code: Facility I.D. #: Phone M Testing Company: Phone #: This data sheet is for inspecting shear valves located Inside dispensers. See PEI/RP1200 Section 10 for the inspection procedure. Product Grade DispenserID# Shear ValveType (Product/Vapor) 1. Is the shear valve rigidly anchored to the dispenser box ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No frame or dispenser island? 2, is the shear section posi- tioned between :Y2 inch above ❑ Yes ❑ No ❑ Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No ❑ Yes ❑ No ❑Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No or below the top surface of the dispenser island? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑Yes ❑ No ❑Yes ❑'No ❑ Yes ❑ No ❑ Yes O No ❑ Yes ❑ No 3. Is the lever arm free to move? ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA 4. Does the lever arm snap shut ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No the poppet valve? ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA 5. Can any product be dispensed ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No when the product shear valve is ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA ❑ NA. closed? A "No" to Lines 1-4 or a "Yes" for Line 5 indicates a test failure. Test Results ❑Pass ❑ Pass ❑ Pass ❑ Pass 13 ass ❑Pass ❑ Pass ❑ Pass70117911 ass ❑ Fail ❑ Fall ❑ Fail ❑ Fail ❑ Fail ❑ Fail ❑ Fall 0 Fail Comments: Tester's Name (print) Tester's Signature