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XERXET TANK INSTALLATION CHECKLIST <br />CORPORATION <br />Fiberglass Underground Storage Tanks <br />Single -Wall (SWT), Double -Wall (DWT), Multicompartment (MCI) and OiVWater Separators (OWS) <br />Complete this checldist, end/ keep t with copies of artytrim *autholiza0ons for variations and/or deviations received from Xerxes. <br />Date of Installation 7b5M Tank Size and Capacity 10' 7Aq=p Q <br />Tank Type SWT DWT MONITORING -FLUID DRY MCT OWS (Circle those that apply.) UL Nunflibas,l t3� <br />Site Owner <br />Site Address .__ MMFrt (�/ S/ock�� / Cr <br />Installing Contractor <br />On -Site Supervisor M_"ARD q(ffxjaY <br />REINSTALLATION1. <br />A. Veual)—�-�1K�y: <br />iepeution: No evidence of damage (holes, Grads, gouges) in tank (Document any damage found. O <br />B. Monitoring -Fluid Tanks: t. Check and record monnorig-fluid level in reservoir. <br />2. Check for monitoring fluid inside and outside of tank <br />C. Plgeical Test Promstalfafion air/soap test completed in accordance with installation instructions <br />D. BMW Material: (Indicate which type.) (DPea gravel or crushed stone as specified by XERXES. <br />2, Other (Requires specific approval by XERXES - describe.) <br />E. Excavator: Hite dimensions are coned per installation instructions for appropriate conditions. <br />F. kft, MONUu wt The inside diameter of the tank has been measured and documented (Dimension -A" below). <br />G. Geomzlse Named: (indicate one.) 4C3) 2 No <br />H' Mote (indicate one) mDry hole (Water is not anticipated to reach tank - area is not su to flooding.) <br />2. Wel hole anticipated may trap water - area issu61'eq to flooding_) <br />I. Trek Loads: (Indicate one.) mTmffit loadsds antidpated <br />2. No traffic loads anticipated -� <br />K. Antihorrra Performed in accordance with installation Instructions. 1. D <br />K. Fittings and Dow MOW eWmen 2. Full slab <br />Components: Coated to protect against corrosion.. <br />e ! <br />j <br />A <br />Baddt44rmterial bed If level and Iiia�yiwftd <br />mrhlmun d 12 vnctee deep, over native <br />by: <br />B. <br />C. <br />rap arateb, bekxe SON tank. <br />Tank Sparing: Tanks are spaced correctly from each other and from excavation according to instructb is. <br />VBA In <br />Vespector No <br />'R -t <br />e�rK+ <br />evidence of damage is found after setting in hole. <br />D. <br />. <br />fklddowrl Steeps: Positioned and secured according to installation instructions. (See SECTION 64 oflnsfailabbn Mantua.)E. B110101111 <br />compacted: Material has been tamped and/or compacted to fill <br />. <br />F. <br />all voids around tank.. <br />TT prOPerybBsesseddokgbeddslkg: (Wet -hole installation only) <br />-- — <br />G. <br />Tani are Maned at proper depth to co sb m in appropless <br />cppjtpng; (wet, dry, traffic or no traffic) <br />A. <br />B. <br />Physical Test: Aidsoap test is completed according to installation Irismniions. <br />Vpftd <br />C. <br />Irasthm Measurement The inside diameter of the tank has been measured and documented (Danenskxr V below. <br />Monitoring -Fluid Tanks: ) <br />. <br />t. Check anti record monit Drina -fluid level in the reservoir _ _ _ (inches)- <br />_ <br />2. Check for monitoring fluid inside tank. <br />D. <br />Installation Manuel: Deliver Installation Manual and Operating Guidelines to owner. <br />Lsg17re7 <br />a -eel _ <br />M taNe must be rreemaed b detemmrine vwtca dnfled m. Fabry dasemaFmeesurament Irish ctione te the <br />neaaaernwg M Wren and moaded as a point orreference, kist"orl Manual, AnbslW daaau•om <br />eedn rteamaerheretian carte Srbespsed measurements show tank deflection and can be dor"ad b are Table bebw. Tab <br />fdorh0 adrg ore sane procedureTAW . <br />MEASUREMENTS END CENTER F1r0 <br />DIAMETER • 8 a 10 12 <br />(F _ — lnbmd Diameter bobs baddlskg •A• <br />DELDWABLE — — Internal Diameter after bard Ill' 19 r- I'mi'm <br />DEFl ECTIDN 12 3M t•1M t -7R 11N DEFLECTIONS 'A'mkhus' �aB--J-YN <br />Vetted by Xw4 Lis (C atz z— Mark the location where deflection <br />measurements were taken. <br />------------- <br />26 <br />EO'd OL£6 Lbs 60Z uOLgDn. gSUOO �puaM db0=T0 66-b0-6ny <br />