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INSTALL_2023
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0548528
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INSTALL_2023
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Last modified
11/4/2024 2:43:27 PM
Creation date
8/24/2023 12:57:59 PM
Metadata
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Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
INSTALL
FileName_PostFix
2023
RECORD_ID
PR0548528
PE
2351
FACILITY_ID
FA0000370
FACILITY_NAME
ORLANDOS ESCALON
STREET_NUMBER
2226
STREET_NAME
JACKSON
STREET_TYPE
AVE
City
ESCALON
Zip
95320
APN
22727016
CURRENT_STATUS
01
SITE_LOCATION
2226 JACKSON AVE
P_LOCATION
06
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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XERXES TANK INSTALLATION CHECKLIST continued <br /> Tank Number Tank#1 0 Tank#2 (t)V 1614_ Tank#3 Tank#4 <br /> A5.INSTALLATION continued(See SECTIONS 5,6,7,8,9, 12 and 14 for instructions and specifications.) <br /> Anchor straps(if used) e V✓ <br /> Geotextile(if used) <br /> Backfill placement&compaction GGJ <br /> Ballasting(if wet hole) N A <br /> Fittings&other metal components <br /> (coated for corrosion protection) 1✓� <br /> Depth of backfill over tank(specify) <br /> Level of backfill after final inspection 11 51 <br /> Type and thickness of surface pad <br /> Piping connections per requirements <br /> A8.POSTINSTALLATION(See SECTIONS 13, 15 and 16 for instructions Lnd specifications.) <br /> Postinstallation tests for air-testable tanks et) G(J <br /> Optional hydrostatic test <br /> Monitoring-fluid tanks(set fluid level <br /> when backfilling&top slab are complete, �i I <br /> and record level in reservoir here) o <br /> Monitoring-fluid tanks <br /> (verify there is no fluid inside tank) Pi� <br /> Containment sump u <br /> (water test successfuq t,w vc"U aw r •t <br /> A7.SITE SKETCH(Indicate specifics of tank installation.) A8.ADDITIONAL NOTES <br /> _- -- (including variations and/or deviations from <br /> instructions,with written authorizations attached) <br /> 1 Iz i� <br /> A9.VERIFYING SIGNATURES <br /> CONTRACTOR Name 6-0)I 1 <br /> I verify that this information is a true record <br /> of the installation of the tanks listed here. <br /> Signat -----_-._- <br /> TANK OWNER/REPRESENTATIVE _Name Date <br /> I verify that this information is a true record <br /> of the installation of the tanks listed here,and <br /> that I have received a copy of the Installation Signature ----- -- — <br /> Manual and this Tank Installation Checklist. <br /> 2011 ZCL Composites Inc. XERXES® www.xerxes.com <br /> a za company ximc05/11pp <br />
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