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Instaflet6on C de6klist Jacketed Steel Underground Storage Tanks Before the installation begins read the Installation Instructions thoroughly. As the tank installation pro- gresses, initial each of the conditions below as each inspection is made. Failure to complete and return this checklist shall prevent issuance of tank warranty. The following information is to be completed by the Installation Supervisor. Installation Date Steel Tank No.: Tank Jacket No.: Tank Owner Site Address Installation Contractor Installation Supervisor Verified by: 1. Handling: Lifting lugs were used and the tank was not damaged. 2. Site Storage: No evidence of scrapes,, holes, or drag marks found. 3. Pre-installation Testing: (A) A 1 psi air-pressure soap test was done and no evidence of leaks were found. Yes No (B) Tank was equipped with a vacuum indicator and maintained a continuous vacuum prior to installation. Yes No All leaks discovered were repaired and the tank was re-tested. 4. Bedding&Backfill: a.Sand—per specifications. b. Pea Gravel—per specifications. c. Other— s. Excavation Size: Per our specification. 6. Excavation Preparation: The hole is smooth and clean of debris. 7. Backfilling: Backfilling was carefully supervised and no evidence that the Tank Jacket was struck by the tamping bar. There was also no evidence that any foreign debris fell into excavation. 8. Anchoring: Hold down straps were used: Yes No If yes, then Strap Cushions were used under the hold down straps. 9. Final Testing: A 2 psi air pressure hold test was performed before backfilling to grade. 10. Attaching Standpipe: Cross fitting was cemented to pipe. After all the information above is com- plete, detach and mail this Installation TOTAL CONTAINMENT, INC. Checklist to Total Containment, Inc. 15 East Uwchlan Avenue using the pre-addressed envelope pro- Exton, Pennsylvania 19341 vided.