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XERXES* TANK INSTALLATION CHECKLIST <br />CORPORATION <br />Fiberglass Underground Storage Tanks <br />Single -Wall (SWT), Double -Wall (DWT), Multicompartment (MCT) and OIVWater Separators (OWS) <br />:omplete this c1ecidist, and k pity / copies of any wr part authorizations for variations and/or deviations received from Xerxes. <br />Date of Installation —, Tank Sae and Capacity &/S O._—I-D <br />Tank Type SWT @�) MONITORING -FLUID DRY MCT OWS (Circle those that apply.) UL Number <br />Site Owner 1--14c <br />Site Address .S SS <br />Installing Contractor <br />On -Site Supervisor . <br />mr <br />mAni m <br />2. Check for monitoring tk)Id inside and outside of tank <br />c. Plryscel Teat Prefrstalation a dsoap rest competed In accordance with kstallatbn irewctans <br />D. Backfill! Malarial: (indicate which type.) 6�ea WM or cntstod same as specified by XERXES.... .. . <br />2 Other (Requires spack approval by XERXES- describe.) <br />E Excavation: Hole dimensions are correct per ktsshallatlon instructions for appropriate conditions. . <br />F. Internal Maamxertnent The inside diame of the tank asu <br />has been measured and docrmtenled (Ditonslon 'A'below). <br />G Gecaxde Util6ad: (indicate one.) 1. Y 2 No <br />H. Hole Condition: (Indicate one.) Dry hole (Water is rot anticipated to reach tank - area Is not subject brooding.) <br />2 Wet hole (Excavation may trap water- area IS subject to ODDding ). <br />1. Tnft Look (Indicate one.) e"I'Tralfic bads anticipated <br />2. No traffic bads anticipated <br />J. Mdgrkg: Performed in accordance with installation bsbuceons. 1. Deadmen 2. Full sly <br />K F&V and Other Mate) Conponsrds Coated to protect against corrosion.. . . . . <br />2. DURING • <br />A BaddFr Aral bed is level and Is a minimum of 12I des deep, am ratke Will or slab, before seting tank . . . . . <br />S. Tait Spatig: Tanks are spaced Correctly from each other and from excavation according to instructions; . . . . . <br />C. Vsual Inspection: No evidence of damage is found after setting in hole. <br />D. 11%40wrt Strels: Posi iorned and secured according to installation instructions. (See SECTION 64 of Insfablion Manual) <br />E BaM competed Material las been tamped and/or compacted to fill all voids around tank. <br />F. Tank is property belsebd during bedditg: (wet -hole installation onty) <br />G Totlr(s) we burled at proper daps to concur to appiopdeb ccndtlors: (wet, dry, traffic a no traffic) <br />3. '• • <br />A. Physical Test Air/soap test is canpieted according to installation instructions,. . <br />B. haemal 14e118iramert The inside diameter of the tank las been measured and documented (Dimermon'B' below). . <br />C. Monitoring -Fluid Tanks: 1. Check and record monibrirg-fluid level in the reservoir (inches). . <br />Verified by: <br />ALE <br />WWMZT—� <br /><yt-- <br />Verified by: <br />2. Check for monitoring fluid inside tank. . <br />D. bsMatim Maxmk Deliver Installation Manual and Operating Guidelines to owner. — <br />4. DEFLECTION <br />Al t w is nant be m MMW b de m"" vertical ddeebw Fosow � tM•tl *min t m Nate- a Manual. An ii M delecilon <br />ma mmnert le taken and receded as a pokd of restate. SubsegtaM meastranahte showl•itkdrIrcl o drd m be oonpaad to ane Table below. Take <br />each measurement from the sans Glhg using the sane p oodItre. <br />TWAETER <br />D <br />4 <br />8 <br />8 <br />10 <br />12 <br />(Feet) <br />ALLOWABLE <br />DEFLECTION <br />112 <br />3M <br />1-1M <br />1.12 <br />1�4 <br />(Indies) <br />MEASUREMENTS CENTER END <br />Internal DerietarbeforebodoN 'A' 9' IU¢ <br />Inbrtal Dlamear albr baddltYtO V 9 r- t t 11Le Im DEFLECTIONS 'A'n*wl' = $__ <br />Verified by: `l-Krlriio �o-t. ♦Y.,c/ _ Mark the location when deOectim <br />mesewe .k con Is4.n <br />26 <br />O� <br />ZO'd Oi£6 Li✓•S 60Z uopqDn..r •}suoD 4puaM d£O=iO 66 -b0 -tiny <br />