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XERXES O TANASTALLATION CHECKLIS- <br /> CORPORATION Fiberglass Underground Storage Tanks <br /> Single-Wall(SWT), Double-Wall.(DWT),Multicompartment(MCT)and OillWater Separators(OWS) <br /> Complete this checklist,and keep H with copies of any written authorizations for variations and/or deviations received from Xerxes. <br /> • Date of Installation r/ - 2-C. -d 3 Tank Size and Capacity �-!5' wo <br /> • Tank Type SWT DWT MONITORING-FLUID DRY MCT OWS (Circle those that apply.) UL Number ZO / <br /> Site Owner 7 6 vzvt) 1Vr SeorZe Z Lqd <br /> • Site Address A19H3 5 Bt-JC L?t 4G 5iwkAD,ed 64 <br /> • Installing Contractor 9(.4err.bLv.r20rt1mewr2otee y�llL /�JSSeI �J lY1u . 7lte LJaA <br /> • OnSlteSupervisor—_ �> /� ��UCyylG l�vSSell • /Y1vL�i�tlro " CIA a <br /> • Verified by: <br /> 1. PREINSTALLATIi ! A. Visual Inspection:No evidence of damage(holes,cracks,gouges)in tank.(Document any damage found.)..................................... <br /> B. Monitoring•Fiuld Tanks: 1.Check and record monitodng-fluid level in reservoir. .............................................................................. <br /> 4155 <br /> 2.Check for monitoring fluid Inside and outside of tank............................................................................... <br /> C. Physical Test: Preinstallation airisoap test completed in accordance with installation Instructions....................................................... <br /> D. Backfill Material: (indicate which type.) 1.Pea gravel or crushed stone as specified by XERXES......................................... 5 — <br /> ERXES–describe.).............................. <br /> 2.Other(Requires specific approval by X <br /> ... — <br /> E. Excavation: Hole dimensions are correct per installation instructions for appropriate conditions......................................................... <br /> F. Internal Diameter Measurement: The hemaldiarnelerofthetank's maasuied and documented onlIldlnarnall rnSec4an4belav)•••• <br /> G. Geotextile Utilized: (Indicate one.) 1.Yes 2.No.......................................................................................................................... <br /> H. Hole Condition: (Indicate one.) ry,hole(Water is not anticipated to reach tank–area is not subject to flooding.)................ <br /> 2.Wet hole(Excavation may trap water–area is subject to flooding.)...................................... <br /> I. Traffic Loads: (indicate one.) 1.Traffic loads anticipated.......................................................................................................... — -- <br /> 2.No traffic bads anticipated............ ......................................:................ <br /> ................... <br /> ® J. Anchoring: Performed in accordance with installation instructions. .Deadman 2.Full slab................................................... <br /> K. Fittings and Other Metal Components: Coated to protect against corrosion...................................................................................... <br /> DURING2. INSTALLATION Verified by: <br /> A. Backfill-material bed is level and Is a minimum of 12 Inches deep,over native soil or slab,before setting tank....................... <br /> B. Tank Spacing: Tanks are spaced correctly from each other and from excavation according to instructions......................................... <br /> C. Visual Inspection: No evidence of damage is found after setting in hole............:...................................................................._........... <br /> D. Hold-down Straps: Positioned and secured according to installation instructions.(See SECTION 6.4.oflnstalla6on Manual.)......... <br /> E. Backfill Compacted: Material has been tamped and/or compacted to fill all voids around tank........................................................... <br /> F. Tank is properly ballasted during backfilling: (wet-hole installafion only)......................................................................................... <br /> G. Tank(s)are buried at proper depth to conform to appropriate conditions: (wet,dry,traffic or no traffic)....................................... <br /> POSTINSTALLATION3. Verified by: <br /> A. Physical Test: Air/soap test is completed according to installation instructions.................................................................................... <br /> E intertnlDlameterMeasummentThe Internal diameterofthetardc'smeasaedanddoc d(FrralInismalDlarrslerinSection4below)............. <br /> C. Monitoring-Fluid Tanks: 1.Check and record monitoring-fluid level in the reservoirCinches)......................................... <br /> i 2.Check for monitoring fluid inside tank...................................................................................................... <br /> D. Installation Manual: Deliver Installation Manual and Operating Guidelines to owner. .....:................................................................... <br /> 4. DEFLECTION <br /> All tanks must be measured to determine vertical deflection. Follow deflection-measurement instructions(Section 14)in the Installation Manual. An <br /> initial internal-diameter measurement is taken and recorded as a point of reference. Subsequent internal-diameter measurements show tank deflection and <br /> can be compared to the table below. Take each measurement from the same ftting using the same procedure. <br /> END CENTER END <br /> External Tank INTERNAL-DIAMETER MEASUREMENTS <br /> Diameter 4 6 6 t0 <br /> J12,4 InfialInternalDiameter(beforebackfilling) gt(Ft) Final Internal Diameter(after backfilling)Allowable Initial Internal Diameter minugqse �`Deflection 112 314 1.1141.112 Final lntemat{yamer � <br /> rn fe Mark the location where internal-diameter <br /> (In.) Notified by .,'� � measurements were taken. <br /> r e <br /> 27 <br />