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Inspection
<br /> Checklist
<br /> Month/Year. { – --St a+11
<br /> station Mame: n�3 $ 'T'R@kC-1C 1 W0
<br /> Addiess-
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<br /> nX,,,, ; .i ;: €" isa.e. 4 ;a>f� tJ�rsli•twG i 3iaS,3 �3 YGlI.11Jf ('\GLIJV F Jy"JLGtita �-ate::y'; fv}r. ALL!/
<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 Long.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 Manuel for inspection
<br /> vapor recovery systems. Place aChack 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 /> �13
<br /> �#the M th
<br /> {Ilse TRAFFIC Cfli+ls and SAFETY VESTS) Z 5 i6 1f 1 5 6 `i 3 1 Zfl 21Z 23 24 Z5 Z6 1 Z8 29 3D 3
<br /> TANK AREA 4 _
<br /> 1.Vent line PV valve(s)-present yellow sticker,no vapor shadows ,�' ✓ ti/.Y
<br /> z. Spill containers-clean and dry W__ -_ _-_- ___— r ✓ �, ✓✓ ✓ ts" a,, I,
<br /> 9•Spill container drains-operative and closed,chain attached(It applicable) �,/ �/�,,•✓ ✓ ✓' �/ ,..>y!
<br /> 4.Vapor caps--gaskets present&tight,caps not missing,broken or loose yr 1 L✓ Poo, ✓ �,. ✓
<br /> 5,Vapor adapters-tight on riser,dry break poppet is not m1ss1hg1damageet ✓ vP ✓ ✓ ;r 1/
<br /> s. Fill caps-gaskets present and tight,caps not missing broken or loose ,. ,/ ✓
<br /> 7.Fill adapters-attachsd tightly to riser,inslde gasket not missing or torn ,/ ✓ L ✓,,,,;r.✓
<br /> a. Fill tube(coaxial spring-loaded)present,round in rnot broken or sa ✓ ✓n ` ✓
<br /> m sP 9 gy/ng
<br /> 9,Coaxial gasket-in place,sealing vapors � _ _ — v y''°� ✓ ,�
<br /> Mo.i'iA tuba-(2-Pobit)present,round _ ✓ �� ✓✓
<br /> DISPENSER AREA
<br /> ii,Air district decals-leg/bM operating instructions,correct Complaint phone# -- v v v r/ v°✓ v L,�►
<br /> 12. Hoses-CARB-approved,no kinksAuerslslits LRD installed correctly TT_
<br /> ✓ i,. ,� ,i �.. ,� v v ✓
<br /> ia, Breakaways-CARS-approved,no liquid stain/dust buildup y.✓ ,/ ;^ t✓ ,�%' J
<br /> -14.Nozzles-CARB-approvers has all clamps,swivels work smoothly,no leaks f 4,r ✓ v *✓ J
<br /> Is. Nozzle hotel-open latches present and operating correctly_ ✓ v
<br /> is.Nozzle bellows and faceplates tight on nozzle,no tears/slits,good seal . ✓ ✓ ✓
<br /> 17. Nozzle spouts-not loose,not out-of-round,have latch devices Y t/ ,�`,r ✓ c/
<br /> is.Nozzle vapor valves-no�vapor shadows em/#/ng from noazle �' y,,. ,/ ✓ r�r , a i' }
<br /> 9a. Hose Retractor-present with a 10".oriess hose loop unless LRD present ✓ �, � � y
<br /> INSPECT AT LEAST ONCE PER WEEK
<br /> 20.pram va or hose to remove excessive gasoline ) ,t� 4`: FrI
<br /> INSPECTOWS INMAl,S: 77
<br /> r1Z.
<br /> ;� L
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