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A 01 r 11, <br />, <br />FOR THE <br />TANK <br />In compliance with part 280 of Title 40 of the Code of ELUTRONe TANK DATA <br />Federal Regulations, this document may be implemented to <br />meet Subpart B, paragraph 280.2 (e), CERTIFICATION OF The U.L. Label and serial number is on the top centerline of the <br />INSTALLATION. tank and also listed on the delivery document. <br />The installer must initial all sections below representing SIZE IN GALLONS U.L. SERIAL NUMBER <br />that the installer has read, was cognizant of and has com- <br />pleted, as applicable, all sections of the PLASTEELe — <br />ELUTRONe Tank Installation Instructions attached hereto. <br />Return completed form to manufacturer to activate <br />warranty. _ <br />INSTLLATI CHECK–OFF — — <br />COMPLETION LIST INSTALLATION COMPANY <br />SECTION INITIAL DATE <br />I.GENERAL <br />II. VISUAL INSPECTION <br />III. HANDLING <br />IV. EXCAVATION DEPTH, BEDDING AND BACKFILL <br />V. ANCHORING SYSTEMS <br />VI. TESTING <br />VI E TI G• JACKETED <br />NAME <br />ADDRESS <br />CITY, STATE, ZIP <br />TELEPHONE <br />i. V N N <br />INSTALLATION COMPLETION/SUPERVISOR'S SIGNATURE <br />VIII. PLASTEELD SEALING PROCEDURES <br />INSTALLATION DESCRIPTION <br />The responsible supervisor's signature below represents <br />that phases I through VIII were properly completed per the <br />PLASTEEL° ELUTRONO Installation Instructions: <br />INSTALLATION SITE <br />SIGNATURE DATE <br />ADDRESS <br />PRINT NAME <br />CITY, STATE, ZIP <br />PLASTEELe TANK OWNER <br />YOUR PLASTEEL® TANK MANUFACTURER IS: <br />NAME <br />NAME <br />ADDRESS <br />ADDRESS <br />CITY, STATE, ZIP <br />CITY, STATE, ZIP <br />SIGNATURE DATE <br />TELEPHONE <br />RETURN COMPLETED FORM TO MANUFACTURER TO ACTIVATE WARRANTY , <br />FORM INST CERT -1193E <br />