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Tank Specific Information TANK NUMBER �-� 14. Underwriter Laboratories label or tank serial number. 15. Tank type.* (Indicate SW, DW, SW-OWS, or DW-OWS for each tank) 16. Interstitial Monitor type.** (Indicate HYDRO, DRY, VAC or PRES for each tank) 17. Tank capacity. (Indicate unit of measurement and record the capacities for each tank) 18. Tank free of visual damage. (Document damage found and attach to this form) 19. Monitoring fluid visible on inner or outer tank wall. (Indicate Yes or No for each tank) 20. Pre -Installation air/soap test performed without leaks. Indicate which test in Section D you used per tank: 21. Hydrostatically monitored tanks: Indicate Yes or N/A for each step completed per tank: • Sensor sits on tank top • Check and record monitoring -fluid level in reservoir Annular space vented Select one:: _ X Gallorls _ ❑ Liters lb T4L4,m eyi — Off KOS — 22. Vacuum monitored tanks: record vacuum date record vacuum level * SW = Single WallTank • DW = Double -Wall Tank • SW-OWS = SW Oil/Water Separator • DW-OWS = DW Oil/Water Separator ** HYDRO = Hydrostatic • DRY = Dry interstice space with probe • VAC = Vacuum • PRIES = Positive Air Pressure Measurement instructions are found in Section 11 of Tank Installation Instructions. 1) First Vertical Diameter Measurement (Section 11, Figure 11-1) 2) Second Vertical Diameter Measurement (Section 11, Figure 11-2) 3)Third Vertical Diameter Measurement (Section 11, Figure 11-6) Measurement A -Tank deflection with backfill at,tank top (subtract Measurement 3 from Measurement 1 above) Refer to Table 11-1 for max. deflection values. 4) Fourth Vertical Diameter Measurement (Section 11, Figure 1 T-7) . 5) Fifth Vertical Diameter Measurement (Section 11, Figure 11-8) 6) Calculate the final vertical diameter measurement (subtract Measurement 5 from Measurement 4 above) Measurement B -Tank deflection at subgrade (subtract Calculated Value (6) from Measurement 1 above) Refer to Table 11-1 for max. deflection values. If Measurement A or Measurement B exceeds the values shown in Table 1-1, immediately contact Tank Technical Support prior to proceeding with the installation. CSI Tank Technical Support (800) 537-4730 31 �?: -�,r 9 7 5 4)9 TABLE 11-1 Tank Diameter Maximum Deflection 4' 1/2 (12mm) — y4FS — — Off KOS — 22. Vacuum monitored tanks: record vacuum date record vacuum level * SW = Single WallTank • DW = Double -Wall Tank • SW-OWS = SW Oil/Water Separator • DW-OWS = DW Oil/Water Separator ** HYDRO = Hydrostatic • DRY = Dry interstice space with probe • VAC = Vacuum • PRIES = Positive Air Pressure Measurement instructions are found in Section 11 of Tank Installation Instructions. 1) First Vertical Diameter Measurement (Section 11, Figure 11-1) 2) Second Vertical Diameter Measurement (Section 11, Figure 11-2) 3)Third Vertical Diameter Measurement (Section 11, Figure 11-6) Measurement A -Tank deflection with backfill at,tank top (subtract Measurement 3 from Measurement 1 above) Refer to Table 11-1 for max. deflection values. 4) Fourth Vertical Diameter Measurement (Section 11, Figure 1 T-7) . 5) Fifth Vertical Diameter Measurement (Section 11, Figure 11-8) 6) Calculate the final vertical diameter measurement (subtract Measurement 5 from Measurement 4 above) Measurement B -Tank deflection at subgrade (subtract Calculated Value (6) from Measurement 1 above) Refer to Table 11-1 for max. deflection values. If Measurement A or Measurement B exceeds the values shown in Table 1-1, immediately contact Tank Technical Support prior to proceeding with the installation. CSI Tank Technical Support (800) 537-4730 31 �?: -�,r 9 7 5 4)9 TABLE 11-1 Tank Diameter Maximum Deflection 4' 1/2 (12mm) 6' 3/4" (19mm) 8' 1'A (31 mm) 10' P/z" (38mm) 12' 13/4" (44mm) 4