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MRX <br /> CHECKLW <br /> t WRP�,1�;POwi�:, * erg, 1 t UngrF Dass Unaergroulld Storage Tanks <br /> Single-Wall (SVV7), Douole_4Vali (OWT), h4ultioompartment(MCT)and 0ILA'ater Separators (4'ff'tfS) <br /> Complete this checklists and keep it with copies of any written authorltations for variations andlor deviations rowtved from Xerxes;, <br /> • Date of Installation !`7— C>3 Tank Size and Capaaiiy <br /> Tank Type SWC WT T(3Rl --FLUID DRY MCT ®SVS (Circle these that apply.) UL Number Z Zi7 <br /> Site owner <br /> SiteAddrests. A-,V <br /> g installing Contractor t ZIP r <br /> ® on-Sits Supowlsor <br /> Verified by: <br /> A. Vrsua'ins n:No evidence of da (hc'es,cracks,gouges)in tank.(Docurttent Bray dam found).................................... <br /> 6*5 <br /> S. monttarfng-Fluid Tanks: 1.Check and record rnc,-.tciriq•Auid levet h rwrvoir. ................................................................... <br /> ........... <br /> 2.Check for rnondorq fltad Inside and outside of tank ........................................................................ <br /> Q. Physical Test: Preinstollatlon airi6oau test wr.profrd ii acocrdance w O installation inmcfions..................:.................................... <br /> D. >3aiekfili Tial: (Indicatewift t;Poi gravel cr crushed stone as s by XERXES........................................ <br /> 2.Odrsir(Requ;res specific approval by X£ -describe.)........... ................ . <br /> E. Excavation: Hole dirrensions are corrsot per in1wa5or:inshuctionsfor appropr Wons.......................................... .... 7 <br /> Intemal Cietnetor MsasuramenL The. of the wd in ).... <br /> G. GAotextits utilized: (Indicate one.) Yes No ....................................................rea........t ....oct.,........d..................,..... <br /> i!. Holo Condidon: (Indicate orae.) *,2,, <br /> Water is not anticipated to reach tank <br /> -area is net sutrloct to ftksodirtg.)................ <br /> 2:WvZbOn may trap water-area$s �ectta flooding.)..................................... <br /> 1. T Loads: (Indicate one.) 1 T ......................._............................................................................. - <br /> 2.No trafklOfids an W... ...............,......,...........,....................................,...,. <br /> .......... <br /> Anchoring.- peri dins canoe ins an in ons. t. rn6n 2 Fuat sash............................................. <br /> .......:. <br /> K. Flitingagnd Wer MOW CornponoritL Coaled to protactaga ns#cormslon_.......... ..................................................., <br /> Verified by: <br /> A. ��eidi$i�krtsrlal is Wet and is a rMnlmim of 12 loobts p,avae a soil or slab,before setting ink ..................... <br /> S, Tom*Socing.,'Tanis are spaced correctly from each other and from excavaticin according to Instructions......................................... <br /> C. lllsuai los on: No evidence of damage is found after settrq in hole.......... ................................................................... <br /> D, H fun Straps: Positioned and secured acctrdin;to Irstalieticn insstruu (See SECTION 6A of instetia±ion ManaaQ. <br /> E. eackf}lt Comp": %jaWal has been tamped and:.compacted to M ail voids around tank..... .......................« <br /> E Tank is property baltestad during backfilling: (wel-WO ins clan only)..................................... <br /> G Tanks}are tsurted M proper depot to Couto"to appropriate conditions: (wet,dry,traffic or no traffic)......................... <br /> Verified ay: <br /> f <br /> installation n .,.,...... <br /> Ptayetcal2 : Att►Aaap test is tetsd ding <br /> to i Instructions.............................................�..,...,...`4 below......,...., -— <br /> A. <br /> Se*r <br /> horwowdiormenAmrat Tne of ill lark is ....................................... <br /> matti';crin A,tki'ieveP in the tesatvolr ®3 Onohss). <br /> G: Monitoring•Fluld Tan#a; t.Che an d reootd g. ... . .................. ........ <br /> 2.Check for monitoring Said Inst tank.. - <br /> p,. Instaitatton Manual: GeCsysr Instaila n t tanua arra^,,pe wGng Guidelines 10 owns .......... <br /> ..................... . <br /> All tantk$must he measured to detertn rte.vertical deft fo`avw deftsence. easlut uerdt le�I-dismetef r* re�is the ow tantior,k�dette&ion and <br /> inidal internaraiameter meas}s:ernertt is taker:and mwtad as a point of raterArase. Subs same procedure. <br /> cava be compared;o t t table below. Take each rneasura�t:r irotkt LIE earns Ftting using trNt3 CENTER END <br /> $tSTE .Qt�MEYER I M UREMENTS /s <br /> External Tank i _ T <br /> Diameter i + j s ti 10 1� lnta4 internal Giarneter(before bacldiflir�) <br /> Cd� .l Fnal'raemaf Diameter(after backfilling) �' <br /> EFtl lr it 3i1rt:MSi Dia ter minus �® 9 S 14'S <br /> 0t:�i irf 0 tl ti I <br /> 11: <br /> Allwab#@ 1 <br /> QAflection `1'2 3'4 1<1te ¢4 1.'21.3;4 r:.r �iii:�. iari ". i3 E.d=?�.t.E�o�`=�etis�n�rei�Ycera�iarr:aizr <br />