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°fir .`� a� a1r ab: afr' aPr ab aPr a/i aff' afi aG °� <br /> s e s e e s►a qe p' qe i►e a►e qe qs qe qe pw ieIEnvp Mr, <br /> ee. <br /> 1 <br /> Y7 7,777' <br /> IN <br /> s►e 'XPi <br /> . THE <br /> •av; <br /> IMP <br /> TANK <br /> de, <br /> rP� <br /> !►e• r 'di <br /> In compliance with part 280 9f Title 40 of the Code of. ELUTION© TANK DATA <br /> Federal Regulations,this docun*nt may be implemented to <br /> ► meet Subpart B !►`• <br /> p ,.paragraph 280.2(e),CERTIFICATION OF The U.L.Label and serial number is an the top centerline of the <br /> INSTALLATION. tante and also listed on the delivery document. <br /> .!G The installer mustinitial all sections below representing SIZE IN GALLONS U.L.SERIAL NUMBER <br /> that!►�' that the installer has read, was cognizant of and has com- <br /> pleted,'as applicable, all sections of the PLASTEELID Fogil <br /> ELUTROatallationin,tructions attached hereto. L51 112-1 <br /> /Return completed form to manufacturer to activate f <br /> I. rranty. <br /> 1 STALL <br /> i <br /> COMPLETION LIST <br /> INSTALLATION P Y <br /> Pari <br /> •fie;I <br /> '►® SECTION INIT DATE !i®.�I <br /> _ Fair 1/C2x cu,�llru� �- �E.r;ro!i troi j <br /> 1. GENERAL NAME <br /> 11. VISUAL INSPECTION <br /> !►°• <br /> 111. HANDLING rP ADDRESS <br /> IV. EXCAVATION DEPTH, BEDDING AND BACKFILL <br /> !►® V.ANCHORING SYSTEMS , , CITY,STATE,ZIP ,j- <br /> V1.TESTING - e (�l(`o) `SSB — �Q' <br /> ti <br /> VII:VENTING:JACKETED tr TELEPHONE atr. <br /> >►® <br /> VIII. PLASTEEL® SEALING PROCEDURES INSTALLATION COMPLETIONISUPERVISOR'S-SIGNATURE <br /> �t <br /> ++. INSTALLATION OESCRIPTI N The responsible supervisor's signature below represents <br /> ► that phases I through VIII were properly completed per the <br /> INSTALLATION SITE PLLASTEELm ELUTROW Installation Instructions: <br /> .%►;. — tri»ref 44f •.!� <br /> ADDRESS S ATURE DATE !® <br /> k'{ xf <br /> ®js CITY,STATE,ZIP PRINT NAME afi <br /> C51� LASTEELv TANK OWNER YOUR PLASTEEL® TANK MANUFACTURER IS: <br /> NANAME <br /> �`. (�� NAME. ► . <br /> ADDRESS 4 f :La s <br /> ADDRESS i <br /> ®f Qrrr.STA CITY,STATE:ZIP <br /> SIGNATURE DATE TELEPHONE <br /> v r; <br /> !► RETURN COMPLETED FORM TO MANUFACTURER TO ACTIVATE WARRANTY <br /> _ <br /> FORM INST CERT--1193E <br /> !►�, <br /> _als' ali afi �Ir'• � afi afi_ ali I afi '�li ''fi '�fr�' '`Py '�li yP�' •�/' <br />