X hits on this document

63 views

0 shares

0 downloads

0 comments

11 / 24

Section 7: Stage I and II Inspection (cont’d.)

7.c. Air and Radiation Management Administration Inspection Report (Submit completed copy of pages 11 & 12 to Air and Radiation Management Administration)

Maryland Department of the Environment Air and Radiation Management Administration Suite 715, 1800 Washington Boulevard Baltimore MD 21230 410-537-3231 STAGE I AND II VAPOR RECOVERY SYSTEMS INSPECTION REPORT

Owner:

Operator/Lessee:

Address:

Address:

Telephone:

Stage I Vapor Recovery System Condition of Fill:

Witness Fuel Drop: Yes Comments:

No

Telephone:

Tank Vent Condition: Location, height, protected

from traffic and weather? Yes

No

Fill and Vapor Swivel Adaptor Installed: Y

Comments:

N

Stage II Vapor Recovery System

Vapor Balance System / Vacuum Assist System (Circle One)

EQUIPMENT (No. Present) Nozzles: Hoses: Dispensers: Date Stage II Installed:

MANUFACTURER

MODEL NUMBER

TEST REQUIREMENTS

Balance System

Vacuum Assist System

Liquid Blockage: Pass

Leak Test: Pass

Fail

Fail Date

Dynamic Back Pressure: Pass

Date ____ Fail

____

Date

____

Liquid Blockage: Pass

Leak Test: Pass

Fail

Air to Liquid Ratio: Pass

Fail

Date

___

Date ___ Fail

Date

___

Frequency Liquid Blockage: Every 5 years Dynamic Backpressure: Annually Leak Test: Annually Air to Liquid Ratio: Annually

Notify the MDE in writing within 5 days of ANY TEST FAILURE, including pre-tests.

Healy Vacuum Assist System: Model 400 - Nozzle Regulation Test: Pass

Fail

Date

_____

Vapor Return Line Tightness Test: Pass Model 600 & 800 – Air to Liquid Ratio Test: Pass

Fail Fail

Date _____ Date _____

Vapor Return Line Vacuum Integrity Test: Pass Equipment Inspection (include description, i.e. good, ok, cracked hose, etc.)

Fail

Date

_____

MPD #1 #2 #3 #4 Comments:

#5 #6 #7 #8 Comments:

  • *

    Operator must inspect equipment daily. Verify log is being kept.

Form Number: MDE/WAS/COM.055 Date: April 3, 2007 TTY Users: 800-735-2258

Facility I.D.

_________________

Page 11 of 24 Recycled Paper

Document info
Document views63
Page views63
Page last viewedSat Dec 10 19:22:22 UTC 2016
Pages24
Paragraphs1161
Words17459

Comments