HomeMy WebLinkAboutSHEAR VALVE 2022) )
SHEAR VALVE OPERATION INSPECTION
Facility Name: Owner
Address: Address
City, State, Zip Code: City, State, Zip Code:
Facility I.D. #: Phone#:
Testing Company: Phone#:
This data sheet is for inspecting shear valves located inside dispensers. See PEI/RP1200 Section 10 for the inspection procedure.
Product Grade
Dispenser ID#
Shear Valve Type (ProducVVapor)
1. Is the shear valve rigidly
anchored to the dispenser box □Yes □No □Yes □No □Yes □ No □Yes □No □Yes □ No □Yes □No □Yes □ No □Yes □Noframe or dispenser island?
2.Is the shear section posi-tioned between½ inch above □Yes □ No □Yes □ No □Yes □ No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □Noor below the top surface of thedispenser island?
3.Is the lever arm free to move?□Yes □No □Yes □No □Yes □No □Yes □No □Yes □ No □Yes □No □Yes □No □Yes □No□NA □NA □NA □NA □NA □NA □NA □NA
4.Does the lever arm snap shut □Yes □No □Yes □ No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □Nothe poppet valve?□NA □NA □NA □NA □NA □NA □NA □NA
5.can any product be dispensed □Yes □No □Yes □ No □Yes □No □Yes □No □Yes □No □Yes □ No □Yes □No □Yes □ Nowhen the product shear valve is □NA □NA ONA ONA ONA ONA □NA □NAclosed?
A "No" to Lines 1-4 or a "Yes" for Line 5 indicates a test failure.
Test Results □Pass □Pass □Pass □Pass □Pass □Pass □Pass □Pass□Fail □Fall □Fail □Fail □Fall □Fail □Fail □Fail
Comments:
• Tester's Name (print) ______________ _ Tester's Signature ____________________ _
)
□Yes □No
□Yes □No
□Yes □No□NA
□Yes □No□NA
□Yes □No□NA
□Pass□Fail
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CIRCLE K
5634 STINE RD
BAKERSFIELD, CA 93313
2701270
B&T SERVICE STATION CONTRACTORS
CIRCLE K
87 91
PROD PROD
87 91 87 91 87 91
PROD PROD PROD PROD PROD PROD
X X X X X X X X
X X X X X X X X
X X X X X X X X
X X X X X X X x
X X X X X X X X
X X X X X X X X
RYAN WITTENBERG 10.12.2022
5 5 6 6 7 7 8 8
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SHEAR VALVE OPERATION INSPECTION
Facility Name: Owner
Address: Address
City, State, Zip Code: City, State, Zip Code:
Facility I.D. #: Phone#:
Testing Company: Phone#:
This data sheet is for inspecting shear valves located inside dispensers. See PEI/RP1200 Section 10 for the inspection procedure.
Product Grade
Dispenser ID#
Shear Valve Type (ProducVVapor)
1. Is the shear valve rigidly
anchored to the dispenser box □Yes □No □Yes □No □Yes □ No □Yes □No □Yes □ No □Yes □No □Yes □ No □Yes □Noframe or dispenser island?
2.Is the shear section posi-tioned between½ inch above □Yes □ No □Yes □ No □Yes □ No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □Noor below the top surface of thedispenser island?
3.Is the lever arm free to move?□Yes □No □Yes □No □Yes □No □Yes □No □Yes □ No □Yes □No □Yes □No □Yes □No□NA □NA □NA □NA □NA □NA □NA □NA
4.Does the lever arm snap shut □Yes □No □Yes □ No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □Nothe poppet valve?□NA □NA □NA □NA □NA □NA □NA □NA
5.can any product be dispensed □Yes □No □Yes □ No □Yes □No □Yes □No □Yes □No □Yes □ No □Yes □No □Yes □ Nowhen the product shear valve is □NA □NA ONA ONA ONA ONA □NA □NAclosed?
A "No" to Lines 1-4 or a "Yes" for Line 5 indicates a test failure.
Test Results □Pass □Pass □Pass □Pass □Pass □Pass □Pass □Pass□Fail □Fall □Fail □Fail □Fall □Fail □Fail □Fail
Comments:
• Tester's Name (print) ______________ _ Tester's Signature ____________________ _
)
□Yes □No
□Yes □No
□Yes □No□NA
□Yes □No□NA
□Yes □No□NA
□Pass□Fail
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� -:::,-11) � �-:::::s '°
QJ :::::s 0. � ::!. ::!, & o·:::::s s. V\ l -0
� � QJ "" 0 s a. 0 :::::s
QJ :::::s 0.
V\ 11) 8 :::::s g. '< g :::::s s s· 3 11) :::::s -E C: ·Er3�-�C �2;19:a-: 11) 11'1
·wo:i·laaJ1s1.pal'fllll11 'Jll laaJlSt.pa1 nQ p,nnQTJISlQ ·panrwJaC! sr 8unJoonau JO uop:inpoJC!aJ J.l4lJn1 ON ·n1uo asn S,ililSUil)TT JOI 0£·80-2202 uo Jlf13Sll!lll1 H\lNllSAtl� 01 pasua:in 1e,Jille!W Pill4ZTJfi00:J
CIRCLE K
5634 STINE RD
BAKERSFIELD, CA 93313
2701270
B&T SERVICE STATION CONTRACTORS
CIRCLE K
87 91
1 1
PROD PROD
87 91
2 2
87 91
3 3
87 91
4 4
PROD PROD PROD PROD PROD PROD
X X X X X X X X
X X X X X X X X
X X X X X X X X
X X X X X X X x
X X X X X X X X
X X X X X X X X
RYAN WITTENBERG 10.12.2022