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TANK INSTALLATION CHECKLIST <br /> TO INSTALLER:After tank installation,deliver the Installation Manual with the completed Tank I nsta I lati on Checklist to the tank owner.Retain a copy of <br /> each for your records. <br /> TO OWNER:After insta I lation,retain the I imited warranty,the Installation Manual and completed Tank I nsta I lation Checklist for future reference and to <br /> facilitate any warranty claim. <br /> INSTALLATION DATE(S): If) 112-3zy PERSON COMPLETING FORM: <br /> - ' I S+Z)Ck-+.O <br /> INSTALLATION ADDRESS: 14('Yb-�- kr'40J Wq C 6: <br /> TANK INFORMATION TANK#1 TANK#2 TANK#3 TANK#4 <br /> Tan k type-Single-Wal I(SW),Dou ble-Wal I(DW) 11)Li <br /> Tank Usage(Fuel)-Fuel,DEF,Pipeline Sump Rje_� -b 55 F <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 t <br /> Nominal Tank Capacity-give in gallons or liters(and note which) 1 70,000 qcl (0, c e-1 000'q IL <br /> lf applicable,UIJULC#(read from tank label)-yes or no 3�1 <br /> WE INFORMATION(See Section 1) TANK#1 TANK#2 TANK#3 TANK#4 <br /> Primary backfill meets Appendix C requirements-yes or no <br /> Secondary backfill material will be used-yes or no <br /> —-_ A- <br /> Secondary backfill meets our requirements-yes or no <br /> Geotextile will be used-yes or no U <br /> Excavation-shored or not shored <br /> Tank will see traffic loads(H20 or HS20)-yes or no <br /> Hole condition-dry or wet <br /> Anchoring system will be used-yes or no f <br /> If applicable,anchoring system used-cleadmen oranchorslab r <br /> 4;a� <br /> ION INSPECTION AND TIESTIN6(See Sedlons 3 and 41 TANK#1 TANK#2 TANK#3 TANK#4 <br /> Shipping damage-yes or no <br /> P 111111�A <br /> REINSTALLAT <br /> _�h i 7�_o e3 <br /> L Lo <br /> oss of vacu um-yes or no <br /> Monitoring fluid visible on interior of tank-yes or no <br /> tie <br /> 0 <br /> Monitoring fluid visible on exterior of tank-yes or no uZA tj P_S <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 reservoir for double-wall wet tanks '14 <br /> If required,tank passed pressu re/soap test-yes or no <br /> :� XERXES" 37 <br />