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a] <br />XERXES® Ank Installation ChecAt <br />TM <br />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 and/or deviations received from Xerxes. <br />• Date of Installath <br />• Tank Type SWT <br />• Site Owner <br />• Site Address <br />Tank Size and Capacity <br />DWT MONITORING -FLUID DRY MCT OWS (Circle those that apply.) <br />STREET <br />- Installing Contractor <br />CONTRACTOR NAME STREET <br />- On -Site Supervisor <br />CITY <br />CITY <br />UL Number <br />STATE ZIP <br />STATE ZIP <br />PREINSTALLATION1. <br />A. Visual Inspection: No evidence of damage (holes, cracks, gouges) in tank. (Document any damage found.) .......................A`!`R. <br />B. Monitoring -Fluid Tanks: 1. Check and record monitoring -fluid level in reservoir............................................................................... <br />2. Check for monitoring fluid inside and outside of tank...................................................................AJ0.111 <br />4 <br />C. Physical Test: Preinstallation air/soap test completed in accordance with installation instructions .................................... <br />A.��c+-' <br />............ <br />D. Backfill Material: (Indicate which type.) 1ea gr r crushed stone as specified by XERXES......................................... <br />12 <br />2. OTher (Requires specific approval by XERXES - describe.)... ................... <br />E. Excavation: Hole dimensions are correct per installation instructions for appropriate conditions .................................. <br />3....... <br />......... <br />F. Internal Diameter Measurement: The internal diameterof the tank is measured and documented (Initial Internal Diameter in SECTION 4 below).... <br />G. Geotextile Utilized: (Indicate one.) 1. Yes 2. No...........................................................................................................r0.0 <br />...... <br />H. Hole Condition: (Indicate one.) Dry I ater 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..................................................................................................IZ� <br />d .................................... ................................................../ <br />J. Anchoring: Performed in accordance with installation instructions. 1. Deadmen 2. Full slab.............................N..../.:....... <br />K. Fittings and Other Metal Components: Coated to protect against corrosion....................................................................AM........ <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 . ............................. ..y. <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. of Installation Manual.) a� <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 />-O <br />A. Physical Test: Air/soap test is completed according to installation instructions.................................................................................... <br />B. Internal Diameter Measurement: The internal diameter of the tank is measured and documented (Final Internal Diameter in SECTION 4 below).... <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. Containment Sump Water Test: Fill the containment sump assembly with water to check for leaks .................................................. <br />E. Installation Manual: Deliver Installation Manual and Ooeratino Guidelines to owner.......................................................................... <br />Verified by: <br />Verified by: <br />Verified by: <br />All tanks must be measured to determine vertical deflection. Follow deflection -measurement instructions (SECTION 14) in the Installation Manual. <br />An initial internal -diameter measurement is taken and recorded as a point of reference. Subsequent internal -diameter measurements show tank deflection <br />and can be compared to the table below. Take each measurement from the same fitting using the same procedure. <br />Internal -Diameter Measurements r; End center End <br />Initial Internal Diameter (before backfilling) <br />Final Internal Diameter (after backfilling) �- - <br />Initial Internal Diameter minus 16, , , , <br />Final Internal Diameter = Deflection <br />Mark the location where internal -diameter <br />Verified by: measurements were taken. <br />External Tank <br />Diameter <br />4 <br />6 <br />8 <br />10 <br />12 <br />(Feet) <br />Allowable <br />Deflection <br />112 <br />314 <br />1-114 <br />1-112 <br />1-314 <br />(Inches) <br />27 <br />I to <br />