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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, <br />INSTALLATION DATE(S): EVz) (, I'LL <br />INSTALLATION ADDRESS: <br />PERSON COMPLETING FORM <br />TANK MIFpRNIATiI <br />SIiE MNM <br />Tank type — Single -Wall (SW), Double -Wall (DW) '� ij b LAJ <br />Tank Usage (Fuel)— Fuel, DEF, Pipeline Sump ( n <br />#3 <br />Tank Usage (Water) — Potable Water, Water Collection <br />S <br />Primary backfill meets Appendix C requirements — yes or no <br />Secondary backfill material will be used — yes or no <br />Tank Usage (Wastewater)— Grease Interceptor, Septic, Industrial Waste- <br />o <br />itoring fluid visible on interior of tank - yes or no <br />J <br />Secondary backfill meets our requirements—yes or no <br />water/Chemical <br />N <br />Monitoring fluid visible on exterior of tank- yes or no <br />Requirements met for double-wall tanks shipped under interstitial <br />vacuum - yes or no. If yes, record the value. <br />M <br />j k <br />Tank Usage (Oil/Water Separator) <br />Record fluid level in reservoir for double-wall wet tanks <br />6t " <br />Geotextile will be used —yes or no <br />Nominal Tank Diameter— give in feet <br />14 GS <br />If required, tank passed pressure/soap test — yes or no <br />Nominal Tank Capacity — give in gallons or liters (and note which) <br />r <br />U6dxwl <br />W aj? <br />Excavation — shored or not shored <br />Tank will see traffic loads (H20 or HS20) — yes or no <br />If applicable, UUULC # (read from tank label) —yes or no <br />q916 2 Ro I <br />F !0 121 <br />Hole condition — dry or wet <br />KNW'[ION dee Section <br />PRFJNSTAUATION INSiPECiION ANDTE51iMG (See Sections 3 and 4) TANK 1€1 iAiUK#2 TANK` <br />#3 <br />LANK#4 <br />S <br />Primary backfill meets Appendix C requirements — yes or no <br />Secondary backfill material will be used — yes or no <br />L <br />o <br />itoring fluid visible on interior of tank - yes or no <br />J <br />Secondary backfill meets our requirements—yes or no <br />�� <br />N <br />Monitoring fluid visible on exterior of tank- yes or no <br />Requirements met for double-wall tanks shipped under interstitial <br />vacuum - yes or no. If yes, record the value. <br />M <br />j k <br />a <br />j `� <br />Record fluid level in reservoir for double-wall wet tanks <br />6t " <br />Geotextile will be used —yes or no <br />14 GS <br />If required, tank passed pressure/soap test — yes or no <br />Excavation — shored or not shored <br />Tank will see traffic loads (H20 or HS20) — yes or no <br />,�o✓emsL2 <br />e j <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 />XERXES® 37 <br />BY SHAWCOR <br />#3 <br />LANK#4 <br />U�Shipping <br />damage -yes or no <br />of vacuum - yes or no <br />o <br />itoring fluid visible on interior of tank - yes or no <br />J <br />o <br />Monitoring fluid visible on exterior of tank- yes or no <br />Requirements met for double-wall tanks shipped under interstitial <br />vacuum - yes or no. If yes, record the value. <br />M <br />j k <br />a <br />j `� <br />Record fluid level in reservoir for double-wall wet tanks <br />6t " <br />5 t��" <br />If required, tank passed pressure/soap test — yes or no <br />XERXES® 37 <br />BY SHAWCOR <br />