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TANK INSTALLATION CHECKLIST <br /> TO INSTALLER:After tank installation,deliver the Installation Manual with the completed Tank installation Checklist to theta nk 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 /> INSTALLATION DATE(S): sla 11.243V PERSON COMPLETING FORM: <br /> INSTALLATION ADDRESS: y� ��� C/�- <br /> TANK INFORMATION j TANK#1 j TANK#2 TANK#3 TANK#4 <br /> Tank type-Single-WaII(SW),Double-Wall(DW) _t)W I W <br /> Tank Usage(Fuel)-Fuel,DEF,Pipeline Sump e( - e <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 q�l <br /> Nominal Tank Capacity-give in gallons or liters(and note which) ;2-yow 91 (0,0W 5r-1 <br /> If applicable,ULIULC#(read from tank label)-yes or no F_gg6( k0k <br /> SITE INFORMATION(See Section 1) TANK#1 f 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 I I <br /> Secondary backfill meets our requirements-yes or no <br /> Geotextile will be used-yes or no I <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 <br /> If applicable,anchoring system used-dead men or anchor slab <br /> I <br /> r7Shipp'iin <br /> ON INSPECTION AND TESTING(See Secdons 3 and 4)1 TANK#1 'TANK#2 TANK#3 , TANK#4 <br /> damage-yes or no �� <br /> acuum-yes or no <br /> ngfluid visible on interiorof tank-yesornc c) <br /> ng fluid visible on exterior of tank-yes or no N d1 <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-wail wet tanks 5 a <br /> If required,tank passed pressure/soap test-yes or no e <br /> XE RXES" 37 <br /> BY SHAWCOR <br />