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W <br />[MonthlYr: C5/— 05— —zo// 1 <br />Inspection Checklis mit <br />Station ,Q,-:375 -T�<kNCY I <br />Address.- gl '37 zn5 —T 9 0 C V <br />Coaxial/ 2 -Point Phase I and Balance Phase 11 Vapor Recovery Systems I Facil" <br />This form %vas 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 twig) Balance Phase 11 Record descriptions of the noted defects and repairs on the Daily Repair Loo. accessible In the Operations & Maintenance Manual for Inspection <br />vapor recovery systerns. Place aChack rna;k In Record your initials at the bottom of the form after completing each days by the Air Poltution, Control District for a period of at least two years. <br />each box where your Inspection revealed no impaction, Keep copies of werk orders andfor equipment part recelpts <br />problems, and an "X" in each box where your <br />D <br />(Use TRAFFIC CONES and SAFETY VESTS) I 11213 4 5 6 7 8 -1 'I'l <br />"l ay of the Month <br />C' <br />TANK AREA <br />t. VentIllne IPV valve(s) -prespnj, yollowsricker, no vaper st?adows <br />ON <br />12. Spill containers -rdean and dry- <br />ONE <br />No WEEM <br />M <br />ro rd 0 <br />ME <br />Zr K* WN 7 <br />mrd a <br />M <br />M M <br />MEMO <br />ONES <br />mom <br />soon' <br />marldeRWAN Wa OMEN <br />i s. Hoz2l a b a If ows a P d fa os p I a te s -6gh t an "=Ie, no 1,1 ar,Vslit s, goo d so al <br />17.14czAe spouts -Aot loose, not out-af-rwnd, have latch devices <br />M <br />ii. Air district decals -log.-We oparatrrq instruaons, rwact complaintphone <br />Zr K* WN 7 <br />M M <br />MEMO <br />ONES <br />soon' <br />i s. Hoz2l a b a If ows a P d fa os p I a te s -6gh t an "=Ie, no 1,1 ar,Vslit s, goo d so al <br />17.14czAe spouts -Aot loose, not out-af-rwnd, have latch devices <br />M <br />0 <br />OMENS <br />NOSES <br />M <br />I! 1 (4, Noz�Je vapor valves -oo Yafvr shadows em(tUng ft7? nozzle <br />f W-1 - --. -1. - <br />0 <br />Nicol <br />- <br />MR <br />mom <br />smoom <br />MONO <br />W <br />U <br />E <br />11 <br />