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11 <br />SITE SKETCH (Indicate specifics of tank installation.) <br />}} <br />j a I <br />�l <br />t , <br />VERIFYING SIGNATURES <br />CONTRACTOR <br />riveirii�that this information is a true record of the installation <br />u of the tanks listed here. <br />r rr <br />Name_ �q —CQ JA+-ty_66+nachfS <br />Telephone_ %iO (036 -1�T(j Q// - <br />Email:rn fCCovf�-/-C< <br />,Address: 3 Zp(o Luy w►� -Dr <br />�,l,r,� rrar�o>✓c�, C�" S S��Y 2 <br />Signature: <br />Date: - — X �n►/ S <br />APPENDIX E <br />ADDITIONAL NOTES <br />Note any vanahon, anrkor deviations from <br />in,,trurtions (and atia(h written authorizations): <br />TANK OWNER/REPRESENTATIVE <br />I verify that this information is a true record of the installatier� .Of the <br />tanks listed here, and that I have received a copy of the Installation <br />Manual and this Tank Installation Check.ist. <br />Name: 6p t-�i ; csTMC-1`�TS j NL <br />Telephone: q�,5- j 2-q- <br />Email: �A �� (ST <br />Address: (co clj N EL <br />q�l7LKY0N CA' <br />Signature:��.-- <br />Date <br />TO INSTALLER: After tank installation, deliver the Installation Manual with the completed Tank installation Checklist to the tank owner. Retain a a <br />of each for your records. <br />TO OWNER: After installation, retain the limited warranty, the Installation Manual and completed Tank Installation Checklist for future reference <br />to facilitate any warranty claim. <br />0 <br />ZCL' I XERXES AI FEN <br />Scanned by CamScanner <br />