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INSTALLATION CHECKL, _T _ Xerxes Century-Cast Fiberglass Underground Storage Tank(s) Double Wall To: Installation Supervisor From: Xerxes Corporation Subj: Installation Checklist Read the preceding Tank Installation Instructions, then fill in the information below. As the tank installation progresses, fill in each applicable inspection,testing and installation checklist item below,initialing the items as its conditions are satisfactorily met.(Refer to Installation Instructions for details.)The tank's U.L.number can be found on the U.L.label next to the lifting lug. When the checklist is complete,tear off at the dotted line and mail to: XERXES CORPORATION,7901 Xerxes Avenue South,Minneapolis,MN 55431. INSTALLATION DATE(S) TANK'S U.L. NUMBER SITE OWNER SITE ADDRESS INSTALLATION CONTRACTOR street cur sive zip INSTALLATION SUPERVISOR PRIOR TO INSTALLATION: Verified by: A. Visual inspection. No evidence (holes,cracks, deep scrapes) in domes, or flats of damage to the tank from physical abuse or a blow from a hard object. B. Physical testing. Completed in accordance with current Xerxes Double Wall Installation Instructions (5 psig pressuri- zations and soap test). C. Backfill material(indicate material type). 1. Pea Gravel per specification in Installation Instructions. 2.Crushed Gravel or Stone per specification in Installation Instructions. 3.Other(requires specific approval by Xerxes rep.)Describe: D. Excavation hole size.Hole dimensions are correct per Installation Instructions for stable and unstable walls. E. Hole conditions(select one): 1.Dry hole.Ground water elevation not anticipated to reach tank and area not subject to flooding.(Dry hole installation) 2.Wet hole.Ground water elevation expected to reach tank or area subject to flooding.(Wet hole installation) F Traffic load(select one): 1.Traffic loading anticipated. (Requires deep burial per Installation Instructions.) 2. No traffic loading. (Allows normal burial per Installation Instructions.) DURING INSTALLATION: A. Backfill material bed is level and at 12"(300mm)minimum depth over native soil or slab prior to setting tanks in place. B.Tanks set in place with correct spacing from wall and other tanks. C. Deadmen and tie downs positioned and secured in accordance with Installation Instructions.(Wet hole installation) D. Backfill material tamped and compacted to fill all voids around tank. E.Tank properly ballasted during backfill.(Wet hole installation only)Never fill secondary(external)tank with ballast. F Tank(s)buried at proper depth to conform to wet or dry hole;traffic or no traffic conditions. INSTALLATION TESTING: All tanks with manways must be inspected from the inside after installation. Visually inspect the tank for any signs (cracks,holes,indentations)of physical damage. MEASUREMENT OF DEFLECTIONS: A. All tanks must be measured to determine vertical tank deflection during installation. Interior diameter of tank Interior diameter of tank prior to backfilling. after backfilling to subgrade. Deflection (A) - (6) _ Maximum Allowable Deflections: Tank Diameter Deflection 4' '12" 6 3/4ir 8 1'A 10 1 Y2' Vertical deflection in excess of these values indicates improper installation and voids the tank warranty. XERXES MANUFACTURING FACILITIES XERXES CORPORATE OFFICE 34250 Mills Road 2001 Proform Road 351 North Virginia Avenue 7901 Xerxes Avenue South Avon,OH 44011 Seguin,TX 78155 P.O.Box 99 Minneapolis, MN 55431 (216)327-6051 (512)372-0090 Penns Grove,NJ 08069 (612)887-1890 Building 316 Airport 1210 N.Tustin Avenue (609)299-0632 Industrial Park P.O.Box 6069 P.O.Box 469 Anaheim,CA 92806 Bartow,FL 33830 (714)630-0012 . (813)533-9047