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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 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 /> facilitate any warranty claim . nn <br /> INSTALLATION DATE(S): ttU �� I �j21 PERSON COMPLETING FORM : �.. <br /> INSTALLATION ADDRESS : ✓ we y , C!�- <br /> 13 e v- e 'd <br /> Tank type - Single-Wall (SW), Double-Wall ( DW) W <br /> Tank Usage (Fuel) - Fuel, DEF, Pipeline Sump e� <br /> e, <br /> Tank Usage (Water) - Potable Water, Water Collection <br /> Tank Usage (Wastewater) - Grease Interceptor, Septic, Industrial Waste- <br /> water/Chemical <br /> Tank Usage ( 0il/Water Separator) <br /> Nominal Tank Diameter - give in feet i <br /> Nominal Tank Capacity - give in gallons or liters (and note which ) <br /> wl w� <br /> If applicable, UUULC if ( read from tank label ) - yes or no F: g4l 7witJ Fq4to -2 <br /> SITE INFORMATION (See Section 1 ) TANK 91 ANK #ZWVK <br /> Primary backfill meets Appendix C requirements - yes or no <br /> Secondary backfill material will be used - yes or no � � o <br /> Secondary backfill meets our requirements - yes or no <br /> Geotextile will be used - yes or no <br /> Excavation - shored or not shored 14 CS <br /> .yeti ) <br /> Tank will see traffic loads ( H20 or HS20) - yes or no <br /> Hole condition - dry or wet <br /> Anchoring system will be used - yes or no <br /> If applicable, anchoring system used - deadmen or anchor slab <br /> F'RFJNStAIWTlON INSPECTION TESIING (See Sections 3 and 4j TANK #1 TANK #2 TANK #3 TANK S4 <br /> Shipping damage - yes or no , <br /> C11 <br /> L oss of vacuum - yes or no <br /> V V'. 0 L11 <br /> Monitoring fluid visible on interior of tank - yes or rio f �I\ F <br /> r <br /> Monitoring fluid visible on exterior of tank - yes or no o e <br /> Requirements met for double wall tanks shipped under interstitial 44 <br /> vacuum - yes or no . If yes, record the value . <br /> Record fluid level in reservoir for double-wall wet tanks (Q t <br /> If required , tank passed pressure/soap test - yes or no ` <br /> XE RXES® 3 7 <br /> BY SHAWCOR <br />