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TANK INSTALLATION CHECKLIST <br /> TO INSTALLER:After tank installation,deliver the Installation Manual with the completed Tank Installation Checklist to the tank owner.Retain a copy of <br /> each for your records. <br /> TO OWNER:After installation,retain the limited warranty,the Installation Manual and completed Tank Installation Checklist for future reference and to <br /> facilitate any warranty claim. <br /> INSTALLATION DATE(S): A71✓ PERSON COMPLETING FORM:� ✓ <br /> INSTALLATION ADDRESS: l74C411 t'7/.✓sCt/ � r �'%t� im �C� a <br /> TANKINiORMATION,", " : TANK#1 . TANIG#2 :TANK#3 - TANK#4 =i- <br /> Tank type-Single-Wall(SW),Double-Wall(DW) &) D60 D <br /> Tank Usage(Fuel)-Fuel,DEF,Pipeline Sump <br /> Tank Usage(Water)-Potable Water,Water Collection N � <br /> Tank Usage(Wastewater) Grease interceptor,Septic,Industrial Waste- <br /> water/Chemical �✓�� /� �//9 <br /> Tank Usage(Oil/Water Separator) <br /> Nominal Tank Diameter-give in feet /0 / <br /> Nominal Tank Capacity-give in gallons orliters(and notewhich) Q®� <br /> If applicable,ULIULC#(read from tanklabel)-ds or no g-/y3 22� [31y3 2 <br /> SITEiNFORMATIQN(SeeSection1) .t TANK#1 TANK.k2 TANK#3 TANK#4 <br /> Primary backfill meets AppendixCrequirements�-yes orno V,45 )15 t11"l- <br /> Secondary backfill material will be used-yes or no r <br /> Secondary backfill meets our requirements-yes or no <br /> Geotextile will be used-yes or no j <br /> Excavation-shored or not shored /J <br /> Tank will see traffic loads(H2OorHS20)-yes orno : <br /> Holecondition-dryorwet /� 1 77 <br /> Anchoring system will be used-yes or no <br /> If applicable,anchoring system used-deadmen or anchor slab <br /> PREINSFALCATIO INSPECTIOftANDiES�ING(SeeSectrons.3and4�� TANK#1 t TANK#2 TANK#3 ` ir*STANKd„` a <br /> �. <br /> 4 «, <br /> Shipping damage-yesorno <br /> Loss of vacuum yes or no <br /> Menitoringfluidvisibleonimerioroftank-yesorno � <br /> Menitoringfluidvisible onexterioroftanlc yesorno <br /> Requirements met for double-wall tanks shipped under interstitial <br /> vacuum-yes or no.If yes,record the value. <br /> Record fluid level in reservoirfor double-wall wet tanks 7 <br /> If req uIred,tan kpassed pressure/soap.test-yes orno 5 �65 <br /> ZCL I /SEsRXESO IMOGII19PP 37 <br />