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TANK INSTALLATION CHECKLIST <br /> TO INSTALLER:After tank installation,deliver the Installation Manual with the completed Tank I nsta I lation Checklist to theta nk owner.Retain a copy of <br /> each for your records. <br /> TO OWNER:After insta I lation,retain the limited warranty,the Installation Manual and completed Tank I nsta I lati on Checklist for future reference and to <br /> facilitate any warranty claim. <br /> INSTALLATION DATE(S): PERSON COMPLETING FORM: <br /> INSTALLATION ADDRESS:_11(00q <br /> TANK INFORMATION TANK#1 TANK#2 TANK#3 TANK#4 <br /> Tank type-Single-Wall(SW),Double-Wall(DW) L4j <br /> Tank Usage(Fuel)-Fuel,DEF,Pipeline Sump pue( Fue <br /> Tank Usage(Water)-Potable Water.Water Collection <br /> Tank Usage(Wastewater)-Grease Interceptor,Septic,Industrial Waste- <br /> water/Chemical <br /> Tank Usage(Oil/Water Separator) <br /> Nominal Tank Diameter-give in feet <br /> Nominal Tank Capacity-give in gallons or liters(and note which) ox) 941' <br /> If applicable,UUULC#(read from tank label)-yes or no F,q H G 8b)3Go <br /> SITE INFORMATION(See Section 1) TANK#1 TANK#2 TANK#3 TANIK#4 <br /> Primary backfill meets Appendix C requirements-yes or no <br /> Secondary backfill material will be used-yes or no <br /> Secondary backfill meets our requirements-yes or no <br /> Geotextile will be used-yes or no <br /> %4 AeA <br /> Excavation-shored or not shored <br /> Tank will see traffic loads(H20 or HS20)-yes or no <br /> Hole condition-d ry or wet <br /> Anchoring system will be used-yes or no <br /> If applicable,anchoring system used-cleadmen or anchor slab <br /> STAILLATION INSPECTION ANDTIESTING(See Sections 3 and 4)1 TANK#1 TANK#2 TANK#3 TANK#4 <br /> Shipping damage-yes or no C) <br /> Loss of vacuum-yes or no <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 u nder interstitial <br /> vacuum-yes or no.If yes,record the value. <br /> Record fluid level in reservoirfor double-wall wettanks & 4-, of- 4o 5 <br /> If required,tank passed pressure/soap test-yes or no <br /> XERXESe 37 <br /> BYSHAWCOR <br />