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FORM 2 <br /> VR-201 and VR-202 - Quarterly Inspection and Testing Checklist (1.2) <br /> Checklist results may be used to assist with filling out GDF maintenance log. Date: Page of <br /> Section: 1.2.1 1.2.2 1.2.3 1.2.4 I 1.2.5 <br /> Weekly Nozzle Product Clean Air Separator <br /> Dispenser Unihose or Fuel Fuel Grade VP1000 <br /> Number Grade Tested <br /> Inspection Inspection Dispensing Dispensing Configuration* <br /> - <br /> Complete Check Rate (see FIGURES 1 and 1H) <br /> (circle one) (circle one) (circle one) (circle one) (circle one) Valve (Circle one) <br /> Unihose 87 89 91 87 89 91 Yes No Pass Fail Pass Fail GPM A Open Closed <br /> Unihose 87 89 91 87 89 91 Yes No Pass Fail Pass Fail GPM B Open Closed <br /> Unihose 87 89 91 87 89 91 Yes No Pass Fail Pass Fail GPM C Open Closed <br /> Unihose 87 89 91 87 89 91 Yes No Pass Fail Pass Fail GPM D Open Closed <br /> Unihose 87 89 91 87 89 91 Yes No Pass Fail Pass Fail GPM *Section 1.2.5 only Applicable for <br /> GDF with CAS Installed. <br /> Unihose 87 89 91 87 89 91 Yes No Pass Fail Pass Fail GPM Plug (Circle one) <br /> Unihose 87 89 91 87 89 91 Yes No Pass Fail Pass Fail GPM E Installed Missing <br /> Unihose 87 89 91 87 89 91 Yes No Pass Fail Pass Fail GPM F Installed Missing <br /> Unihose 87 89 91 87 89 91 Yes No Pass Fail Pass Fail GPM <br /> Unihose 87 89 91 87 89 91 Yes No Pass Fail Pass Fail GPM <br /> Unihose 87 89 91 87 89 91 Yes No Pass Fail Pass Fail GPM <br /> Unihose 87 89 91 87 89 91 Yes No Pass Fail Pass Fail GPM <br /> Unihose 87 89 91 87 89 91 Yes No Pass Fail Pass Fail GPM <br /> Unihose 87 89 91 87 89 91 Yes No Pass Fail Pass Fail GPM <br /> Unihose 87 89 91 87 89 91 Yes No Pass Fail Pass Fail GPM <br /> 1-0 <br /> CARB Approved IOM 1 -Systems Scheduled Maintenance—EO's VR-201 and VR-202 <br />