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TANK INSTALLATION CHECKLIST <br /> TO INSTALLER:Alter 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 instal Iation,retain the Imited warranty,the Installation Manual and completed Tank Installation Checklist for future reference and to <br /> facilitate any warranty claim. 77 <br /> INSTALLATION DATE(S): "��✓f i PERSON COMPLETING FORM: <br /> �/e;N^C✓L: 00/_„�,&-rF X'Z',,. <br /> INSTALLATION ADDRESS: <br /> PhScrP?i�c rYtgf 't y, l* �� l w,�w <br /> m' s, x 3 ..+rM.+ n 'A�jM JIFF $ _� .rW'i•; x"? �' y�"dIlY1" � <br /> g <br /> Tanktype-Single-Wall(SW),Double-Wall(DW) S)VJ '0W <br /> 7anit'.U3age(Fuel)4uel D6F,Prp ljheSump — T t'” + <br /> v <br /> Tank Usage(Water)-Potable Water,Water Collection <br /> Taci�USpge(C!ygsCewaYer) �ireasefnierceptor.Septic Industn�IWaste- <br /> watAr{Chemical <br /> Tank Usage(OIIANaterSeparator) � � <br /> Nominal Tank Diameter-give in feet �_ �r <br /> NamfnalTankCapaeitY giueingallansorlitars(`apdnDtewhch} ���t . ":� o;; . <br /> If applicable,UUULC#(read from tank label)-yesorno °(/o�,y <br /> Primary backfill meets AppendixCrequirements-yesorno \ <br /> Secdndarybackfilt ma kHal wih be u ed yesorno h t <br /> Secondary backfl11 meets our requirements-yes or no N <br /> Geglextflswillboused nyesorna ti ;. � -, <br /> Excavation-shored or not shored o tspr✓y� <br /> rikwllseetafFlctoad�(H2Yk�r•EfSO) yesar b `L <br /> Holecondition-dryorwet �r W <br /> Anchoringsystem will beused-yesorno <br /> Ifapplicable,anchoring systemused-deadmenoranchorslab µ <br /> p�A LA7rN <br /> .: Pg 1 e3er ,` 4 til <br /> P�xJ,e.., - ` x o.'. - <br /> Shippingdamage-yesorno4,0 <br /> los3afbacQur�'`yeSorno; '" I�S�tx-- i..k �4- v: � a x . , <br /> Monitoring fluid visible oninterloroftank-yesorno <br /> fNvn(tormgfljdvislb(eon,ezlri8rpftanl(; Yesvrnq N <br /> Requirements metfordouble-walltanksshippedunder interstitial <br /> vacuum-yes or no.if yes,record the value. <br /> �te�pidflUrcflevalityate'se�vpirt'brcYgiJblswallwetianks ;" "� <br /> -E <br /> Ifrequlred,tankpassed pressurelsoaptest-yesorno <br /> aCE ESW <br /> 37 <br /> BY SHAW.COR <br />