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TANK INSTALLATION CHECKLIST TO INSTALLER:After tank installation,deliver the Installation Manual with the completed Tank Installation Checklist to theta nk owner.Retain a copy of each for your records. TO OWNER:After installation,retain the limited warranty,the Installation Manual and completed Tank Installation Checklist for future reference and to facilitate any warranty claim. INSTALLATION DATE(S): A I�2.07- PERSON COMPLETING FORM: A,,., Z L11fa4Q INSTALLATION ADDRESS: TANK INFORMATION TANK#1 TANK#2 TANK#3 TANK#4 Tan k type-Single-WalI(SW),Double-WalI(DW) I�Li D W 11)W Tank Usage(Fuel)-Fuel,DEF,Pipeline Sump ,,e - e 1 - F Tank Usage(Water)-Potable Water,Water Collection i Tank Usage(Wastewater)-Grease Interceptor,Septic,Industrial Waste- water/Chemical Tank Usage(Oil/Water Separator) Nominal Tank Diameter-give in feet �! Nominal Tank Capacity-give in gallons or liters(and note which) 1 70.000G( I to (w { 000 It If applicable,ULLIULC#(read from tank label)-yes or no �, q y (o SITE INFORMATION(See Section 1) ' TANK#1 TANK#2 TANK#3 I TANK#4 Primary backfill meets Appendix C requirements-yes or no Secondary backfill material will be used-yes or no Secondary backfill meets our requirements-yes or no Geotextile will be used-yes or no Excavation-shored or not shored y Tank will see traffic loads(H20 or HS20)-yes or no Hole condition-dry or wet r Anchoring system will be used-yes or no If applicable,anchoring system used-dead men or anchor slab PREINSTALLATIQN INSPECTION AND TESTING(See Sections 3 and 4 TANK#1 TANK#2 TANK#3 TANK#4 Shipping damage-yes or no R-S Loss of vacuum-yes or no - k Monitoring fluid visible on interior of tank-yes or no Monitoring fluid visible on exterior of tank-yes or no Q Requirements met for double-wall tanks shipped under interstitial vacuum-yes or no.If yes,record the value. Record fluid level in reservoir for double-wall wet tanks '14 If required,tank passed pressure/soap test-yes or no :� XERXES® 37