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TOK INSTALLATION CHECKOT <br /> CORPORATION Aberglass Underground Storage Tanks <br /> Single-Wall(SWT),Double-Wali (DWT), Multicompartment(DICT)and Oil titer 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 installation &- 17-03 Tank Size and Capacity _M-r <br /> Tank Type m <br /> d ONITO ING-FLUID DRY MCT OWS (Circle those that apply.) UL Number y <br /> • Site Owner <br /> ® Site Address Go ZA 'i{t c 0 <br /> • installing Contractor ttr ( r <br /> • <br /> On-Site SupervisorZP <br /> ql 0 Maki i l <br /> .• f Verified by: <br /> A. Visual Inspection:No evidence of da (holes,cracks,gouges)in tante(Document any damage found.).................................... <br /> B. Morittoring-Fluld . 1.Check and , ndorir fluid level In reservoir .................................................................... <br /> ......... <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......................................... <br /> 2.Other(Requires speclftc approval by XERXES describe.)................................ <br /> E. Excavation: Hole dimensions are correct per installation instructions for appropriate conditions....... .....................................I....... <br /> F Internal Diameter Measurement: The ktxrd dwnslaroflhela kis measuied ariddoarnwied W Internal Diamelerin Seafion4 )... <br /> G. Geotextile Witzed: (indicate one.) Yes 2.No.......... ........................................... .. ..................................................... <br /> H. Hole Condition: (ind`icate one,) (water Is not anticipated to reach tank—area is not subject to floading.)................ <br /> 2.Wet hole vation may trap water—area is subject to flooding.)..................................... <br /> L Traffic ds: (Indicate one.) re ads anticipated......... .... . ....................................................I......I..................... __s <br /> 2.No traft loads anticipated........ ............................................................................ <br /> tJ. Anchoring., Performed in accordance Installation instructions. 2.Full slab........................ . ...................... <br /> 10 K. Fittings and Other Metal Components: Coated to protect against sion. ....................................................................... .. . <br /> verified by: <br /> A. Backfill-material is level and is a minimum of 12 Inches overnative salt or stab,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 selling In hole.............................................................................................. <br /> D. Hold4own Straps: Positioned and secured aocDrding to installation instructions.(See SECTION 6.4.of Installation Manuel.) ........ <br /> E. Backfill Compacted: Material has bw tamped andlor compacted to III all voids around tank........................................................... <br /> F. Tank Is property ball during fling: (wet-cote installation only)...... ....... ....... ............................................. ` <br /> G. Taink(s)ase buried at proper depth to c to apprMprtate eoadhlons: (Wet,dry,traffic or no trafftc)....................................... <br /> W ifie by: <br /> K Physical Test: Awsoap test is completed according to Installation 1'> tions.. ....... . .... .... ..........................}...... <br /> ..i'W.. _ ... }r.pyt x tlCtlUM1'.... ..... <br /> C. Monftoring-Fluld Tanks: 1.Check and record rrKindorin a level In the reservoir (inches).. <br /> 2.Check for monitoring fluid Inside tank.... ......... ............................................... <br /> Installation Manual: Deliver Installation Manual and Operating Guidelines to owner. ......................................................,.. <br /> i ! <br /> All tanks must be measured to determine vertical deflettift Follow deft rneasurerrient instructions(Section 14)in the Installation Manual. An <br /> initial intemadiameter,measurement is taken and recorded°as a point of reference. Subsequent lntemaNdiianeter measurements show tank deflection and <br /> can be compared to the table below. Take each measurement from the same fitting using the same procedure. HND CENTER END <br /> Externa[Tank iNTERNAL•OtAMEfER MEASURE NT <br /> Dlamgter 4 s a 10 12 initial internal diameter(before bacifiling) �. <br /> (Ft) _ Final internal Diarneter(after backfilling) <br /> Allowable Initial Internal diameter minus <br /> !® �` C..S R 1 0 6 j T i b t1 1i 1Q <br /> Defiecdon 112 , 314 1-114 1,112 1.314 Ficial intemal diameter=de tion K Mark tra rmfon where internal-diameter <br /> (ln.) Vet Pied by, measurements.weretaicen. <br /> 27 <br />