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BACKFILL <br /> Has approved backfill material been used?(Refer to installation instructions) [ ] YES [ ] NO <br /> Has special care been used to ensure backfill compaction along the tank's bottom quadrant? [ ]YES [ ] NO <br /> PIPING CONNECTIONS <br /> (Select any that apply) [ ] Metallic piping used [ ] Non-metallic piping used [ ] Dielectric bushings or <br /> flanges used. <br /> If"No"is indicated on any of the above questions, please provide explanation: (Attach additional sheet if <br /> required.) <br /> Signature&Title of Foreman/Project Engineer Installation Contractor <br /> NOTE: This checklist includes certain key steps in the proper installation of the GLASTEEL II jacketed steel <br /> underground storage tank and is intended only as an aid to tank installers who are knowledgeable and <br /> experienced in underground tank installation. Compliance herewith does not necessarily meet the <br /> requirements of all applicable federal, state and local laws, regulations and ordinances concerning tank <br /> installation. <br /> Modern Welding Company Glasteel II®Installation Precision Test <br /> "Interstitial Tightness Test Method" <br /> 1. The initial vacuum for the test shall be a minimum of 12"mercury. <br /> 2. Test period shall be a minimum of 1 hour for 10,000 gallon tanks and smaller and 2 hours for larger tanks. <br /> 3. Vacuum decreases of less than 5"mercury during the test period indicate the inner and outer tanks are tight. <br /> 4. A vacuum decrease of more than 5"mercury during the test period shall require further investigation. <br /> 5. Contact the representitive from which tank was purchased if further investigation is required. This <br /> precision test will be required upon completion of any investigation. <br /> 6. This test procedure meets Enviommental Protection Agency(EPA)requirements for tightness testing of <br /> empty underground double wall tanks in dry excavations. <br /> Certification of Results <br /> I certify that the interstitial monitor was tested under the conditions in according to the vendor's operating instructions. <br /> I also certify that the evaluation was performed using the methods described in the attached Alternate EPA Test Procedures <br /> of Interstitial Monitors,and that the results presented above are those obtained during the evaluation. <br /> H.Kendall Wilcox,President Ken Wilcox Associates,Inc. <br /> (printed name) # (organization performing evaluation) <br /> • Independence,Mo. 64055 <br /> (signature) (city,state,zip) <br /> April 21, 1994 816-795-7997 <br /> (date) (phone number) <br /> THIS COMPLETED CHECKLIST MUST BE RETURNED TO THE MODERN WELDING COMPANY,INC <br /> SUBSIDIARY FROM WHICH THE TANK WAS FABRICATED TO INITIATE WARRANTY. <br /> SUBSIDIARIES: Modern Welding Company of Florida,Inc. Modern Welding Company of California,Inc. <br /> Corporate Office (270)685-4400 1801 Atlanta Ave. 4141 N.Brawley Ave. <br /> Orlando,Florida 32806 Fresno,California 93722 <br /> Modern Welding Company of Owensboro, 407-843-1270 559-275-9353 <br /> Inc. 407-423-8187(Fax) 559-275-4381(Fax) <br /> 1450 E.Parrish Ave. Modern Welding Company of Texas,Inc. Modern Welding Company of Georgia,Inc. <br /> Owensboro,Kentucky 42303 715 Sakowitz Street 300 Prep Phillips Dr. <br /> 270-683-5323 Houston,Texas 77020 Augusta,Georgia 30901 <br /> 270-684-5245(Fax) 713-675-4211 706-722-3411 <br /> Modern Welding Company of Ohio,Inc. 713-673-4062(Fax) 706-724-8133(Fax) <br /> One Modern Way Modern Welding Company of Iowa,Inc. Modern Welding Company of Texas,Inc. <br /> Newark,Ohio 43055 2818 Mt.Pleasant Road 200 N.Main Street <br /> 740-344-9425 Burlington,Iowa 52601 Rhome,Texas 76078 <br /> 740-344-6018(Fax) 319-754-6577 817-636-2215 <br /> 319-754-8428(Fax) 817-636-2680(Fax) <br /> File:Glasteel 11 checklist, 4/2005 MWCo© <br />