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XERXES ® TANOINSTALLATION CHECKLISP <br /> CORPORATION Fiberglass Underground Storage Tanks <br /> Single-Wall(SWT), Double-Wall.(DWT), Multicompartment(MCT)and Oil/Water Separators(OWS) <br /> Complete this checklist,and keep it with copies of any written authorizations for variations andfor deviations received from Xerxes. <br /> • Date of installation Z& — 03 Tank Size and Capacity GYJC� <br /> • Tank Type SWT DWT MONITORING-FLUID DRY MCT OWS (Circle those that apply.) UL Number 2007(3 <br /> • Site Owner 7--6 l eve rd 1;,-Jc- 5for2e ;3 Z l 4 a <br /> • Site Address 414,gf 5 S, 51A+t 124- qq .9c(c*+-nr� ['a <br /> • Installing Contractor (VA04rrr2 ELr.�th Jt2 4jd('!A0i l e NU l6 f2Usse"IZ& 4,&1e bFer>f I" <br /> • Onsite Supervisor t ,, te e/f F/uc 7/L 12v,�r!/ AI . My/�ij{�o, &)A m <br /> PREINSTALLATION1. Verified by: <br /> A. Visual Inspection:No evidence of damage(holes,cracks,gouges)in tank.(Document any damage found.)..................................... �T5 <br /> B. Monitoring-Fluld Tanks: 1.Check and record monitoring-fluid level in reservoir. .............................................................................. <br /> 2.Check for monitoring fluid inside and outside of tank............................................................................... <br /> C. Physical Test: Preinstallation air/soap test completed in accordance with installation Instructions....................................................... _ <br /> D. Backfill Material: (Indicate which type.) 1.Pea gravel or crushed stone as specified by XERXES......................................... <br /> 2.Other(Requires specific approval by XERXES-describe.)................................. <br /> E. Excavation: Hole dimensions are correct per installation instructions for appropriate conditions......................................................... <br /> F. Internal Diameter Measurement: The intermaidlannielarof1hatankismeasued and doasriertDd(Intel Internal DiamewinSectim4below).... <br /> G. Geotextile Utilized: (Indicate one.) Yes 2.No.......................................................................................................................... <br /> H. Hole Condition: (Indicate one.) 1.Dry 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 /> 1. Traffic Loads: (Indicate one.) 1.Traffic loads anticipated.......................................................................................................... E�P:`L <br /> 2.No traffic loads anticipated.......................... . . . . . . . ..... ................. <br /> J. Anchoring: Performed in accordance with installation instructions. Deadline 2.Full slab..............instructions. ................................. <br /> (0 K. Fittings and Other Metal Components: Coated to protect against corrosion...................................................................................... <br /> INSTALLATION2. DURING 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 /> ..............._........... <br /> D. Hold-down Straps: Positioned and secured according to installation instructions.(See SECTION 6.4.oflnstallafion 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 installation only)......................................................................................... <br /> G. Tank(s)are buried at proper depth to conform to appropriate conditions: (wet,dry,traffic or no traffic)....................................... <br /> 3. POSTINSTALLATION Verified by: <br /> A. Physical Test: Air/soap test is completed according to installation instructions.................................................................................... <br /> B. IrnemalDiametarMeasuremwtThe intemaldiarnetera hetanksmeasixedanddoamanled(FriellriandDianelarinSecfion4bebx}............ <br /> C. Monitoring-Fluid Tanks: 1.Check and record monitoring-fluid level in the reservoir(inches)......................................... <br /> 2.Check for monitoring fluid inside tank...................................................................................................... <br /> D. Installation Manual: Deliver Installation Manual and Operating Guidelines to owner. .....:................................................................... <br /> DEFLECTION4. <br /> All tanks must be measured to determine vertical deflection. Follow deflection-measurement instructions(Section 14)in the Installation Manual. An <br /> initial intemaldiameter measurement is taken and recorded as a point of reference. Subsequent intemaltliameter measurements show tank deflection and <br /> can be compared to the table below. Take each measurement from the same fitting using the same procedure. <br /> END CENTER END <br /> External Tank INTERNAL-DIAMETER MEASUREMENTS <br /> Diameter ' <br /> J314I. <br /> 812 Initial Internal Diameter(before backfilling) !� 3 - <br /> ��(Ft) Final Internalqal Diameter(after backfilling) 4-Allowable Initial Internal Diameter minusDeflection 112 114 1-1/2 1.3/4 Finallnte lame r-gefle�tjgn <br /> ! <br /> (1n') Verified b : /�/1/� 1 Mark the location where internal-diameter <br /> Y measurements were taken. <br /> 27 <br />