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XERXESO WANK INSTALLATION CHEOLIST <br /> CORPORATION <br /> Fiberglass Underground Storage Tanks <br /> Single-Wall (SWT), Double-Wall (DWT), Multicompartment (MCT) and Oil ter Separators (OWS) <br /> 'Complete this checklist, and keep it with copies of any written authorizations for variations and/or deviations received from Xerxes. <br /> • Date of Installation Tank Size and Capacity <br /> • Tank Type SWT DWT MONITORING-FLUID DRY MCT OWS (Circle those that apply.) UL Number <br /> • Site Owner <br /> • Site Address <br /> STREET CITY STATE ZIP <br /> • Installing Contractor <br /> CONTRACTOR NAME STREET MY STATE 71P <br /> • On-Site Supervisor <br /> Verified by: <br /> A. Visual Inspection: No evidence of damage(holes,cracks,gouges)in tank.(Document any damage found.) . . . . <br /> B. Monitoring-Fluid Tanks: 1.Check and record monitoring-fluid level in reservoir. . . . <br /> 2.Check for monitoring fluid inside and outside of tank. . . . . . . . . . . . . . . . . . <br /> C. Physical Test: Preinstallation air/soap test completed in accordance with installation instructions . . . . . . . . <br /> D. Backflll Material: (Indicate which type.) 1.Pea gravel or crushed stone as specified by XERXES. . . . . . <br /> 2.Other(Requires specific approval by XERXES—describe.) . . . . . . <br /> E. Excavation: Hole dimensions are correct per installation instructions for appropriate conditions. . . . . . . . . . . . . . <br /> F. Intemal Measurement: The inside diameter of the tank has been measured and documented(Dimension"A"below). . , <br /> G. Geotextile utilized: (indicate one.) 1.Yes 2.No . . . . . . . . . . . . . . . . . . . . . . <br /> H. Hole Condition: (Indicate one.) 1.Dry hole(Water is not anticipated to reach tank—area is not subject to flooding.). . . <br /> 2.Wet hole(Excavation may trap water—area is subject to flooding.). . . . . <br /> I. Traffic Loads: (Indicate one.) 1.Traffic loads anticipated . . . . . . . . . . . . . . . . . . . . <br /> 2.No traffic loads anticipated . . . . . . . . . . . . . . . . <br /> J. Anchoring: Performed in accordance with installation instructions. 1.Deadmen 2.Full slab . . . . . . . . . <br /> K. Fittings and Other Metal Components: Coated to protect against corrosion. . . . . . . . . . . . . . . . <br /> Verified by: <br /> X Backfill-material bad is level and is a minimum of 12 inches deep,over native soil or slab,before setting tank. <br /> B. Tank Spacing: Tanks are spaced correctly from each other and from excavation according to instructions. . . . . . . . <br /> C. Visual Inspection: No evidence of damage is found after setting in hole. <br /> D. Hold-down Straps: Positioned and secured according to installation instructions.(See SECTION 64 of Installation ManuaL), <br /> E. Backfill compacted: Material has been tamped and/or compacted to fill all voids around tank. . . . . . . . . . . <br /> F. Tank is properly ballasted during backfilling: (wet-hole installation only) . . . . . . . <br /> G. Tank(s)are buried at proper depth to conform to appropriate conditions: (wet, dry,traffic or no traffic) . . . . . . <br /> Verified by: <br /> A. Physical Test Air/soap test is completed according to installation instructions. . . . . . . . . . . . . . <br /> B. Internal Measurement: The inside diameter of the tank has been measured and documented(Dimension"B"below). . . . . . <br /> C. Monitoring-Fluid Tanks: 1.Check and record monitoring-fluid level in the reservoir (inches). . . . . . . . <br /> 2.Check for monitoring fluid inside tank. . . . . . . . . . . . . . . . . . . . . . . . . <br /> D. Installation Manual: Deliver Installation Manual and Operating Guidelines to owner.. . . . . . . . . . . . . . <br /> ylwx • <br /> All tanks must be measured to determine vertical deflection. Follow deflection4neasurement instructions in the Installation Manual. An initial deflection <br /> measurement is taken and mwrded as a point of reference. Subsquent measumments show tank deflection and can be compared to the Table below. Take <br /> each measurement from the same fitting using the same procedure. <br /> END CENTER END <br /> TANK MEASUREMENTS <br /> DIAMETER 4 6 8 10 121 V* <br /> (Feet) Intemal Diameter befbre backfilling "A" <br /> ALLOWABLE <br /> Internal Diameter after backfilling 'B" <br /> 7 <br /> DEFLECTION 112 3/4 1-1/4 1-1/2 1-&4 DEFLECTIONS W minus"B" = — 2 3 4 0 9 10 11 12 <br /> (inches) Verified by: Mark the location where deflection <br /> measurements were taken. <br /> 26 <br />