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TANK INSTALLATION CHECKLIST <br /> TO INSTALLER:After tank!nstallation,deliver the Installation Manual with the completed Tank Installation Checklist to thetank 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): 1-25-21 PERSON COMPLETING FORM: Dale Adams <br /> INSTALLATION ADDRESS: 770 Charter Way Stockton, CA 95206 <br /> X0065125 X006461 X006461 <br /> TANK INFORMATION TANK#1 TANK#2 TANK#3 TANK#4 <br /> Tank type-Single-Wall(SW),Double-Wall(DW) DW DW DW _ <br /> Tank Usage(Fuel)-Fuel,DEF,Pipeline Sump FUEL FUEL FUEL <br /> Tank Usage(Water)-Potable Water,Water Collection N/A N/A N/A <br /> Tank Usage(Wastewater)-Grease Interceptor,Septic,Industrial Waste- <br /> water/Chemical N/A N/A N/A <br /> Tank Usage(Oil/Water Separator) N/A_ N/A N/A <br /> Nominal Tank Diameter-give in feet _ 10' 10, 10, _ <br /> NominalTankCapacity-give in gallons or liters(and note which) 20,000 12,000 8,000 <br /> If applicable,UUULC#(read from tank label)—yes or no B-14365125 i B-14365134 B-14365134 <br /> SITE INFORMATION(See Section 1) TANK#1 TANK#2 TANK#3 TANK#4 <br /> Primary backfill meets Append ix C requirements-yes or no YES LYES YES <br /> Secondary backfill material will be used-yes or no NO Q NO <br /> Secondary backfill meets our requirements'yes or no ^N/A N/A N/A <br /> Geotextile will be used-yes or no _ YES YES YES <br /> Excavation-shoredornotshored SHORED SHORED SHORED <br /> Tank will see traffic loads(H20 or HS20)-yes or no YES YES YES <br /> Hole condition-dry or wet WET WET WET t <br /> Anchoring system will be used-yes or no YES YES j YES <br /> If applicable,anchoring system used-deadmenoranchorslab DEADMEN DEADMEN DEADMEN <br /> PREINSTALLATION INSPECTION ANDTESTING(See Sections 3 and 4)i TANK#1 TANK#2 TANK#3 TANK 94 <br /> Shipping damage-yes or no NO NO I NO <br /> Loss of vacuum-yes or no N/A N/A N/A _ <br /> Monitoring fluid visible on interior of tank-yes or no NONO � NO <br /> Monitoring fluid visible on exterior of tank-yes or no NO NO _ NO <br /> Requirements met for double-wall tanks shipped under interstitial — <br /> vacuum-yes or no.If yes,record the value. N/A N/A i N/A <br /> Record fluid level in reservoirfor double-wall wettanks 7" 7" 7" <br /> If required,tank passed pressure/soap test-yes or no YES YES YES <br /> Z C L I o IMOG1114PP 37 <br />