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APPENDIX <br /> t I` _ a <br /> TO INSTALLER : After tank installation , deliver the Installation Manual with the completed Tank Installation Checklist to the tank owner. Retain a copy <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 and to <br /> facilitate any warranty claim . <br /> INSTALLATION DATE(S ) : L I _ _ PERSON COMPLETING FORM : _ iolcll ,�A aSrl rte,✓ <br /> INSTALLATION ADDRESS : /i /1 LAG_ l'/�'A(IIA G%L � � R <br /> TANi(INEORMATION TANK #7 TANK #2 TANK#3 ' ' `; ' TANK #4 Tank type—Single-Wall (SW), Double-wall ( DW) CC) 0 4V <br /> Tank Usage ( Fuel )-Fuel , DEF, Pipeline Sump <br /> Tank Usage (Water)—Potable Water, Water Collection <br /> Tank Usage (Wastewater)-Grease Interceptor, Septic, <br /> Industrial Wastewater/Chemical <br /> Tank Usage ( Oil/Water Separator) <br /> NominalTank Diameter-give in feet <br /> Nominal Tank Capacity—give in gallons or liters (and note which ) p. OCO CV 0 <br /> If applicable, UW LC # ( read from tank label )—yes or no <br /> 51TE INFORMATION {See section .l) ; TANK #1 ' TANK'#2 � TANK #3 TANK #4 > <br /> Primary backfill meets Appendix C requirements—yes or no j <br /> Secondary backfill material will be used—yes or no //O U <br /> Secondary backfill meets our requirements—yes or no e e/y <br /> Geotextile will be used—yes or no <br /> Excavation —shored or not shored r jj�pAA10 „,�' /Y)rz? <br /> Tank will see traffic loads ( H20 or HS20 )—yes or no <br /> Hole condition—dry or wet olzDIY <br /> Anchoring system will be used—yes or no 4; <br /> If applicable , anchoring system used—deadmen or anchor slab ` r ��� J� t <br /> P.REINS7ALLATION INSPECTION AND TESTING (See sectiono ,JANkil TANK#2 TANK <br /> Shipping damage—yes or no <br /> Loss of vacuum -yes or no 7 <br /> Monitoring fluid visible on interior of tank—yes or no <br /> Monitoring fluid visible on exterior of tank—yes or no <br /> Requirements met for double-wall tanks shipped under interstitial , / <br /> vacuum—yes or no /Y1� <br /> Record fluid level in reservoir for double-wall wettanks " <br /> If required , tank passed pressure/soap test—yes or no f <br /> ; C. { on NextPageZCL <br /> n <br /> m <br />