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l'IVJM r.LiJ�U_j ul <br /> Hl1V_3H IVIN31NN0HIAN3 <br /> 6102 9 I N-1 <br /> APPENDIX E <br /> Tank fnstallation Checklist, <br /> i <br /> TO INSTALLER:After tank installation,deliver the Installation Manual with the completed Tank Installation Checklist to theta nkowner.Retain a copy <br /> of each for your records. <br /> TO OWNER:After installation,retain the limited warranty,the Installation Manual and completed Tank Installation Checklist forfuture reference and to <br /> .facilitate any warranty claim. <br /> INSTALLATION DATE(S): 4 PERSON COMPLETING FORM: Owf'a DECGv4DGo <br /> INSTALLATION ADDRESS: �4/� 501W"f//YI.�jN�ST,Bis✓,%/���/fi�c�_�� <br /> , r r. ..ti s� -. d tv r"Y:.A ..y ?'\ 4.. .z� 45 ., a�. 4 -a.,,.1.. x.5 n 'r`iT "h.•cv.... } �. <br /> 3 ��•f ;fiANK f0 Ay 4 : •r Y51T/t�l�C1t tTlk( '`r iaS4x '(. 13 x T� s` yT • ,, ;, r �u n AN <br /> kxa. <br /> Tank type-Single-Wall(SW),Double-Wall(DW) <br /> dy <br /> Tank Usage(Fuell-Fue1.DEF,Pip,elfrieurrrp <br /> Tank Usage(Water)-Potable Water,Water Collection <br /> Tank Usagee(Wastewater).-Giease.lnterceptorFSepfird <br /> Tridustrial Wastewaterldemical �✓ �/ <br /> Tank Usage(Oil/Water Separator) <br /> Nominal Tank Diameter-give in feet <br /> i NominalTankCapacity-give in gallons.orliters(andnotewhich <br /> If applicable,UUULC li(read from tank label)-yes or no1434W I1-1 3/ <br /> • , ..11-A':a' �t �(K a.�i Arx,R FS,, �'. ��r yyn�y,-r,¢,•G�y -,e•�r s-•• :•�U, <br /> :ink`}''��'' '�hIllfu�•,;y �•f ,,a�„'JC \IQr�'2�.�rT� � �, '.V' k ,LXlr_ /A 1� 3.�.�'€'31_�1YI ,, . r,." :,, „'�.,y�e <br /> Primary backfill meets Appendix C requirements-yes or no VY5 -5 y1f 51 <br /> Secondary backfill material will be used-yesor no <br /> Secondary backfill meets our requirements-yes or no All <br /> Geotexti le will be used-yes or no j 5. S _ <br /> Excavation-shored or not shored <br /> Tank will see traffic foads(H20 orHS20)-yes or no <br /> S S _ <br /> Hole condition-dry or wet v <br /> Anchoring system will be used-yes or no <br /> If applicable,anchoring system used-deadmen or anchor slab <br /> cN <br /> N (`�' ,SP ollllb, (V ( ee Qns 3 anhj l�il ' ;xANI T1IV �z:' T <br /> WcF W: 4- ”' h iP a`:•wc. `* a'Z,;�ka.'� n ..5� h. U. ..:t VL 4:w .�k. <br /> Shipping damage-yes or no A10 <br /> Loss of vacuum-yes or no N <br /> Monitoring fluid visible on interior of tank-yes or no <br /> I -- <br /> Monitoring fluid visible on:exterior of tank:yestrno <br /> Requirements met for double-wall tanks shipped under interstitial <br /> vacuum-yes or no /V/'9 /� /'� <br /> Recordfluid level in reservoir for double-waflwettanks <br /> © <br /> If required,tank passed pressure/soap test-yes or noYleS f <br /> Continued on Next Page w-� > <br /> ZCL XERXES APPENDIX E 45 <br />