Daily Inspection Log / Balance System (Arizona Department Of Weights And Measures)

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Balance Systems
V/R Daily Inspection Log
ARIZONA DEPARTMENT OF WEIGHTS AND MEASURES
4425 West Olive Avenue, Suite # 134 Glendale AZ. 85302
Must Be Kept Under Penalty of Law R20-2-909
Phone: 602-771-4920 or 1-800-277-6675 (Outside of Phoenix Metro)
Agency contact: Shawn Marquez (602) 771-4929
Month: 
Year:
State Ombudsman 602-277-7292
DISPENSERS
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Nozzle Instruction & Oxygenate Decals posted & readable?
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Weights & Measures number posted / readable? (602) 2555211
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Open Dispensers: Check for any leaks or drips.
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Are all lights lit & all displays readable?
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NOZZLES
Are any Bellows torn, cut, ripped?
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Are any Bellows loosened from the nozzle?
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Is the faceplate smooth, not torn, forming a tight seal?
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Is the Nozzle dripping gasoline?
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Have the hoses been drained of residual gasoline DAILY?
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Does the Trigger work properly? Moves freely when Boot NOT depressed & no fuel can be
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dispensed?
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Does the hold open latch work? Properly? 8. Does the auto shut-off work properly?
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HOSES
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Are any hoses cut- crimped- torn flattened- frayed or dragging on the ground?
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Are the hoses loops 10 inches maximum?
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Is the breakaway on the nozzle side of the reactor connection? Is any fuel leaking from the
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connections?
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Are all of the retractors working properly?
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SWIVELS
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Do all swivels move freely? No signs of binding or leaking?
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UNDERGROUND STORAGE TANKS
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Are spill buckets CLEAN & DRY?
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Are the caps locked on securely? With gaskets in place?
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With the caps on, can you turn the pipes?
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Is the fill tube in good condition?
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Are there any dents/ cracks in the fill tube?
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Are the fills labeled correctly by Grade and Oxygenate Type?
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Are PV valves on the vent pipes? Are they damaged?
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PERMITS
Are Permits and licenses posted/ readily available to Regulators?
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Are Inspection & Maintenance logs CURRENT, COMPLETE & CORRECT?
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Are originals/copies of the last 4 gas drops available to Regulators?
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If you are having any problems with the above, immediately tag the equipment 'OUT of ORDER'.
Fill out the Owner Operator Repair/ Maintenance Log and contact Maintenance for repairs. The equipment must be tested by a licensed RSR in order to put the equipment back into service. According to A.A.C. R20-2-602 (B)(1)(c).
Owner Operator ___________________________________
Date ____________
I certify this to be accurate and complete as required under A A C R20-2-907 and R20-2-909 and I acknowledge that not maintaining or
I certify this to be accurate and complete as required under A.A.C. R20-2-907 and R20-2-909 and I acknowledge that not maintaining or
falsification of this document is a violation of this chapter and subject to civil penalties under A.R.S. 41-2115.

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