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TO INSTALLER: After tank installation, deliver the Installation Manual with the completed Tank Installation Checklist to the tank owner. Retain a copy of <br />each for your records. <br />TO OWNER: After installation, retain the limited warranty, the Installation Manual and completed Tank Installation Checklist for future reference and to <br />INSTALLATION DATE(S):- <br />INSTALLATION ADDRESS: <br />COMPLETING FORM: <br />TANKI IFORMATI QN> s <br />TANK#1 <br />TANK#2 <br />TANKIk3 tw <br />z ,TANI(t(4 <br />Tank type - Single -Wall (SW),Double-Wall(DW) <br />1 �� <br />Tank Usage (Fuel)- Fuel, DEF, Pipeline Sump <br />/V <br />Al <br />f/ <br />Tank Usage(Water)- Potable Water, Water Collection <br />/0itoring <br />/ 0 <br />Tank Usage (Wastewater)- Grease Interceptor, Septic, Industrial Waste- <br />water/Chemical <br />A/ <br />�iA <br />A/ <br />Tank Usage (Oil(Water Separator) <br />A/ © <br />�y , <br />10 <br />Nominal Tank Diameter - give in feet <br />C'L <br />DoeV <br />CV&to� <br />Nominal Tank Capacity- give in gallons or liters (and note which) <br />Vloe-5 <br />A= <br />Jr - <br />If applicable, UL/ULC It (read from tank label) - yesorno <br />/ <br />SIT�,INFORMATIQN(SeeSecwn1) <br />`TANK#1 <br />TANKN2 <br />_ TANt�#,3 ` <br />Tl�I�K#;4, �, <br />Primary backfill meets AppendixCrequirements- yesorno <br />1 �� <br />Secondary backfill material will be used -yes or no <br />/V <br />Al <br />f/ <br />Secondary backfill meets our requirements - yesorno <br />/0itoring <br />Geotextilewillbeused- yesorno <br />Excavation- shored or not shored <br />�iA <br />D✓✓y/C� <br />Tank will see traffic loads (H2OorHS20)- yes orno <br />�/ / <br />�y , <br />Hale condition - dry or wet <br />C'L <br />DoeV <br />CV&to� <br />Anchoring system will be used -yes or no <br />Vloe-5 <br />A= <br />Jr - <br />Ifapplicable, anchoring system used - dead men oranchor slab/7/F�p <br />k*�� <br />DtAWrAl <br />`®\®37 XTIMOG0121PP <br />BYSHAWCOR <br />ping damage-yesornoofvacuum-yesorno <br />I <br />Al <br />itoring fluid visible on interior of tank-yesornoi/O <br />/0itoring <br />fluid visible on exterior of tank - yesorno <br />Requirements met for double-wall tanks shipped under interstitial <br />vacuum -yes or no. If yes, record the value. <br />�/ / <br />�y , <br />"Re nrdflwdTevelinreservoirfordouble-wall wettanks <br />611 <br />Ifrequired,tankpassedpressure/soaptest- yesorno <br />Vloe-5 <br />f3 <br />Jr - <br />`®\®37 XTIMOG0121PP <br />BYSHAWCOR <br />