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TANK INSTALLATION CHECKLIST <br /> SITE SKETCH(indicate specifics of tank installation.) ADDITIONAL NOTES . <br /> err d� LH4 Note a ny variations a nd/o r d eviations from <br /> instructions(and attach written authorizations): <br /> Gp,y-;vut otok leak OA a rib <br /> be� Maio, eaa�a/tw�sr.f <br /> o1 r gel CdwOat"t�e <br /> �1 to0a/�n��T 44gY�u;� <br /> �1.►}N. �3to��oatw�«I- �.�k� <br /> 0 oil <br /> �1`6. F� rkcs_ � rib <br /> f IK44� rib A j AAe <br /> dvyyo✓� Uvtd�,- 'fit n rE a <br /> r <br /> VERIFYING SIGNATURES <br /> CONTRACTOR TANK OWNER/REPRESENTATIVE <br /> I verify that this information is a true record of the installation of the tanks I verify that this information is a true record of the installation of the tanks <br /> listed here. listed here,and that I have received a copy of the Installation Manual <br /> and thisTank Installation Checklist. <br /> Name:(W h a. 1i Loilv�fi y " CAC <br /> L Name: <br /> Telephone: 10 .-0o Telephone: <br /> Email: C2a>7 0+T—con c r c6vL^ Email: s <br /> Address: 320(o LAX, L ," Z)I- Address:32 0 GV yv-tif' 1�� <br /> tLRI ko Ca rty d d a, Z <br /> Signature: �^ _ I Signature: <br /> Date: &-6(l / Date: /6—7- ZS� <br /> If 4 <br /> TO INSTALLER:After 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 installation,retain the limited warranty,the Installation Manual and completed Tank Installation Checklist for future reference and to <br /> facilitate any warranty claim. <br /> :� XERXES"' 39 <br />