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TANK INSTALLATION CHECKLIST <br />TO INSTALLER: After tank installation, deIiverthe Installation Manual with the completed Tank Installation Checklist to theta nkowner. Retain a copy of <br />each foryour 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): - <br />INSTALLATION ADDRESS: <br />&/Y PERSON COMPLETING FORM: rJ v4P� Dj�:(--GAS <br />6wb <br />`I" , Z 1 53 <br />TAN1NFDRNIAf101� <br />r TANK1 <br />TANK#2 <br />TANK#3 <br />" TAIVKp4 ,-, <br />Tanktype- Single -Wall (SW), Double -Wall (DW) <br />isj Cy <br />Tank Usage (Fuel) -Fuel, DEF, Pipeline Sump <br />FuBL <br />j=ug <br />Tank Usage (Water) - Potable Water, Water Collection <br />"(*S <br />NC7 <br />Tank Usage (Wastewater)- Grease Interceptor, Septic, Industrial Waste- <br />water/Chemical <br />No <br />`tom <br />Tank Usage (Oil/Water Separator) <br />C—r5 <br />Nominal TankDiameter - give in feet <br />`-% <br />to <br />NominalTankCapacity- giveingallonsorliters(andnotewhich) <br />2-414/61< <br />v5- t 5-14 <br />If applicable, UUULC#(read from tank label-yesorno <br />G32707-107 <br />C,29020(& <br />SJTft`INPORNIATION(Se�Ssdrotr1j, <br />TA�IKN'I{ <br />TAN�C#2 <br />; ,TANK#3t <br />TANK#4,,,' <br />Primary backfill meets AppendixCrequirements- yesorno <br />isj Cy <br />Secondary backfill material will be used -yes or no <br />O <br />NO <br />Secondary backfill meets our requirements - yesorno <br />"(*S <br />NC7 <br />Geotextile will be used -yes or no <br />No <br />`tom <br />Excavation - shored or not shored <br />C—r5 <br />Tank will see traffic loads (H2O or HS20) - yes or no <br />`-% <br />6111.-- <br />Holecondition- dryorwet <br />n <br />qEs <br />Anchoring system will be used -yes or no <br />L(^El <br />If applicable, anchoring system used - deadmenoranchorslab <br />de"eiv-4-N1 <br />411 <br />�R�IJ�ISTALL�TIQFIJNSPEC�'IOINANI3TESTJN�(Ss�Sectjorfs$�rSdAj <br />TANK#1 <br />„7IINKN� ,, <br />£TAJJK#�:""� <br />�yTAN�C#4 sr <br />Shipping damage-yesorno <br />isj Cy <br />Loss ofvacuum- yesorno <br />K)Cy <br />N® <br />Monitoring fluid visible on interior of tank - yesorno <br />NO <br />NC7 <br />Monitoring fluidvisibleonexterioroftank- yesorno <br />No <br />iU <br />Requirements met for double-wall tanks shipped under interstitial <br />vacuum -yes or no. If yes, record the value. <br />C—r5 <br />Record fluid level in reservoi r fo r dou ble-wall wet tanks <br />3N <br />6111.-- <br />If required, tankpassedpressure/soaptest- yesorno <br />n <br />qEs <br />XERXES" 37 <br />