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TANK INSTALLATION CHECKLIST <br /> 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 foryo ur records. <br /> TO OWNER:After installation,retain the limited warranty,the Installation Manual and completed Tank Installation Checklist for future reference and to <br /> facilitate any warranty claim. <br /> INSTALLATION DATE(S): 'I-I-ZZ l PERSON COMPLETING FORM:�'�A , 4"r� <br /> INSTALLATION ADDRESS: 33 7q N bra N l i I✓rJ <br /> TANK INFORMATION TANK#1 TANK#2 TANK#3 TANK 44 <br /> Tank type-Single-Wall(SW),Double-Wall(DW) L� <br /> Tank Usage(Fuel)-Fuel,DEF,Pipeline Sump , �.xf <br /> Tank Usage(Water)-Potable Water,Water Collection <br /> Tank Usage(Wastewater)-Grease Interceptor,Septic,IndustriAWastewater/Chemical <br /> Tank Usage(Oil/Water Separator) <br /> Nominal Tank Diameter-give in feet (-)0 10' rA <br /> acity-give in gallons or liters(and note whiow 6,ts2cILC#(read from tank label)-yes or no <br /> SITE INFORMATION(See Section 1) TANK#1 TANK#2 TANK#3 TANK#4 <br /> Primary backfill meets Appendix C requirements-yes or no -le <br /> Secondary backfill material will be used-yes or no <br /> n0 <br /> Secondary backfill meets our requirements-yes or no <br /> e< <f <br /> Geotextile will be used-yes or no <br /> Excavation-shored or not shored <br /> S�tae� <br /> Tank will see traffic loads(H20 or HS20)-yes or no <br /> YK ya <br /> Hole condition-dry or wet <br /> al- <br /> Anchoring system will be used-yes or no <br /> If applicable,anchoring system used-deadmen or anchor slab <br /> PREINSTALLATION INSPECTION AND TESTING(See Sections 3 and 4) TANIK#1 <br /> TANK#2 TANK#3 TANK#4 <br /> I - Shipping damage-yes or no <br /> Loss of vacuum--yes or no <br /> 0 <br /> Monitoring fluid visible on interior of tank-yes or no h0 h Q <br /> No <br /> Monitoring fluid visible on exterior of tank-yes or no <br /> Requirements met for double-wall tanks shipped under interstitial B <br /> vacuum-yes or no.If yes,record the value. y2 5 <br /> Record fluid level in reservoir for double-wall wet tanks <br /> ------------ <br /> If required,tank passed pressure/soap test-yes or no ` c <br /> LA <br /> XERXES® <br /> BY SHAWCOR 37 <br />